Account Representative II

Cleveland Clinic

1d • Remote

About The Position

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. You will work alongside dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world. The Account Representative performs a specific operational responsibility within a functional unit within Revenue Cycle Management, including customer service, training, insurance billing and follow-up processes for commercial and government payers, insurance verification, cash application, credit balance resolution and/or account reconciliation, and quality review. A caregiver in this position works Monday - Friday, 8:00am—4:30pm (flexible).

Requirements

• High School Diploma or GED.
• Two years patient accounting experience.
• OR Associate's degree can substitute one year of required experience.
• OR Bachelor's degree can substitute two years of the required experience.
• Knowledge of patient accounts which includes customer service, insurance processing, insurance verification and cash application.
• Knowledge of additional specialized functions may be required such as third-party payors, Medicare processing, hospital and physician billing and pricing.
• CPT4/ICD code application.
• Must have excellent verbal and written skills.
• Knowledge of EPIC and billing revenue resolution.

Responsibilities

• Recommend and provide input to execute customer service programs in accordance with changes in insurance reimbursement regulations and data obtained from various groups.
• Provide supervisor/manager with information to assist department liaison with various departments regarding various issues including contract and reimbursement rules.
• Comply, recommend, and assist with the implementation of various management reporting systems to insure accurate and timely reporting of department goals and results.
• Assist with department audits as required.
• Participates in meetings with various payors, internal billing groups and other Cleveland Clinic departments to address discrepancies in payment and provides summary data and trend analysis to Managed Care Business Development for use in contract negotiations.
• In conjunction with supervisor, recommend changes in billing practices intended to reduce payor mis-adjudication of claims and identifies contract language or specific payment methodology contributing to errors in payment.
• Maintain data and develop enhancements to database and other various management reporting systems to ensure accurate presentation of trends in payor reimbursement, error rates, and maximize recovery of underpayments.
• Validate new and existing contracts and reimbursement rules/logic.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees