Job Description Summary
The Hearing Aid Reimbursement and Payer Relations Specialist manages all aspects of hearing device reimbursement, payer policy oversight, and financial performance. This role verifies insurance benefits, interprets coverage policies, supports prior authorizations, ensures accurate coding and claim submission, and mitigates denials. Serving as the primary liaison with insurance carriers, the specialist monitors policy updates, supports contract and pricing alignment, and analyzes reimbursement trends to protect margins. The position collaborates with clinical, billing, finance, and compliance teams to standardize workflows, ensure regulatory compliance, and provide data-driven reporting to support operational and financial decision-making.Entity
Medical University of South Carolina (MUSC - Univ)Worker Type
EmployeeWorker Sub-Type
ClassifiedCost Center
CC000991 COM OTO Audiology & Cochlear Implant CCPay Rate Type
HourlyPay Grade
University-GEN08
Pay Range
Scheduled Weekly Hours
40Work Shift
Day (United States of America)Job Description
Job Duties:
20% - Reimbursement & Benefits Verification
Verify hearing aid benefits and coverage prior to patient appointments
Interpret commercial, Medicare Advantage, Medicaid, and managed care policies
Determine prior authorization requirements
Estimate patient financial responsibility
Communicate coverage details to patients and clinical staff
20% - Payer Relations & Policy Management
Serve as the primary contact for insurance carriers regarding hearing device coverage
Monitor payer policy updates related to hearing aids and audiology services
Escalate coverage denials and negotiate reconsiderations
Maintain payer-specific coverage guidelines and documentation requirements
Support contract negotiations with managed care organizations (if applicable)
20% - Pricing & Financial Oversight
Monitor manufacturer pricing and reimbursement trends
Ensure hearing aid pricing aligns with payer allowable rates
Analyze margins and reimbursement performance
Provide financial impact analysis for new device lines or payer contracts
15% - Revenue Cycle & Compliance
Ensure correct coding (HCPCS, CPT where applicable)
Support clean claim submission processes
Track denials and identify trends
Develop denial mitigation strategies
Ensure compliance with federal and state regulations governing hearing devices
15% - Data & Reporting Track
Reimbursement turnaround time
Revenue per device
Prepare reports for department leadership
Identify operational improvement opportunities
10% - Collaboration
Work with:
Audiologists and division/department leadership
Revenue cycle / billing department
Compliance office
Finance
Educate providers and staff on payer requirements
Create internal workflows for consistent documentation and authorization practices
Skills Preferred
Strong knowledge of insurance policy interpretation
Understanding of managed care contracts
Familiarity with healthcare coding and reimbursement systems
Analytical and financial acumen
Strong communication and negotiation skills
Regulatory awareness
Additional Job Description
Minimum Requirements: A high school diploma and three years professional experience in a related area such as accounting, auditing, finance or commercial lending. A bachelor's degree with multiple accounting courses may be substituted for two years of the required work experience.
Physical Requirements: (Note: The following descriptions are applicable to this section: Continuous - 6-8 hours per shift; Frequent - 2-6 hours per shift; Infrequent - 0-2 hours per shift) Ability to perform job functions in an upright position. (Frequent) Ability to perform job functions in a seated position. (Frequent) Ability to perform job functions while walking/mobile. (Frequent) Ability to work indoors. (Continuous) Ability to work in confined/cramped spaces. (Infrequent) Ability to bend at the waist. (Infrequent) Ability to squat and perform job functions. (Infrequent) Ability to fully use both hands/arms. (Continuous) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Frequent) Ability to reach in all directions. (Frequent) Possess good finger dexterity. (Continuous) Ability to maintain tactile sensory functions. (Continuous) Ability to lift and carry up to 15 lbs., unassisted. (Infrequent) Ability to lift objects, up to 15 lbs., from floor level to height of 36 inches, unassisted. (Infrequent) Ability to lower objects, up to 15 lbs., from height of 36 inches to floor level, unassisted. (Infrequent) Ability to push/pull objects, up to 15 lbs., unassisted. (Infrequent) Ability to maintain 20/40 vision, corrected. (Continuous) Ability to see and recognize objects close at hand. (Continuous) Ability to see and recognize objects at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) Ability to determine distance/relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities. (Continuous) Ability to hear and/or understand conversations. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Continuous)
Additional New Requirements: Computer literacy.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
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