Employee Health Plan Specialist I

Cleveland Clinic

81d

About The Position

Join the Cleveland Clinic team where you will work alongside passionate caregivers and make a lasting, meaningful impact on patient care. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world. As an EHP Specialist, you will perform various HR-related tasks for the Employee Health Plan (EHP) Program. In this role, you will offer exceptional customer service, offering support, answers and referrals to callers as needed. You will develop extensive experience in de-escalating insurance issues, assisting with denials and more, all while making a positive difference in the lives of your fellow caregivers. A caregiver in this role will work 8:00 a.m. – 4:30 p.m., 100% remote after 6 weeks of on-site training at the Cleveland Clinic Administrative Campus in Beachwood, Ohio.

Requirements

• High School Diploma/GED
• Two years of experience in health insurance claims processing, customer service, collection call center or medical facility OR three years customer service interacting with the public by telephone or in person in a similar role or capacity or related experience
• Previous customer service or billing experience.
• PC skills proficiency

Nice To Haves

• Basic understanding of Coordination of Benefits, Willis dependent audit and Cobra process
• Basic understanding of interpreting Explanation of Benefits statements, claim payments and/or denials
• Formal office training
• Experience with EPID
• Knowledge of provider networks

Responsibilities

• Provide customer service regarding EHP health insurance benefits, eligibility and the Healthy Choice premium discount program.
• Answer incoming phone calls, responding to correspondences from EHP members, providers, vendors and internal departments.
• Utilize Workday, Core, Epic, SharePoint, Third Party Administrators (TPA) system(s), Healthy Choice Portal and all associated databases to resolve issues related to registration, insurance company authorization requirements, billing, insurance company explanation of benefits, provider-based billing, claim processing, coding and collections.
• Collect payments, ensuring dollar amounts are posted to the correct debit and according to the patient request.
• Identify issue(s) and resolve issues or refer to appropriate staff for resolution.
• Refer members to correct area for dental, vision, life event changes and other Human Resources related issues.
• Perform other duties as assigned by EHP management, complete regular audits in the Healthy Choice database and perform appeal process for members in Healthy Choice.
• Answer EHP Medical Management Department communications, respond to EHP prior-authorization requests/status and appeal or peer to peer policies.
• Advise members/providers of provider network and prior authorization/post service medical necessity requirements.
• Advise members about general Healthy Choice and Coordinated Care program topics.
• Initiate Healthy Choice enrollment cases and initiate Healthy Choice diagnosis/premium appeals on member’s behalf.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED