Reimbursement Specialist

Cleveland Clinic

1d•Hybrid

About The Position

Join Cleveland Clinic’s Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world class and caregivers are family. Here, you will work alongside a passionate and dedicated team, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world. As a Reimbursement Specialist, you are responsible for policies and protocols related to coding and billing to ensure compliance for the Hematology/Oncology department. In this role, you will create, revise and maintain departmental documents for professional and technical charges, assist with the onboarding and monitoring of new physicians and perform various other research duties as needed. This role is critical to the overall functioning and organization of Cleveland Clinic. A caregiver in this role works on-site, Monday through Friday, from 7:30 a.m. -- 4:00 p.m. during the initial training period. After training is completed, the start time may be adjusted between 7:30 a.m. and 9:00 a.m., with the end time adjusting accordingly. The position then transitions to a hybrid schedule: on-site at Main Campus on Monday, Wednesday and Friday, with remote work on Tuesday and Thursday. A caregiver who excels in this role will: Ensure accountabilities for all services performed and compliance with billing and internal standards is maintained. Identify opportunities and efficiencies in business office functions and operations. Manage patient accounts receivable and conducts denial analysis. Monitor departmental accounts receivable to achieve appropriate reimbursement percentages and maintain financial stability within the department. Analyze accounts receivable to identify inequities in payment. Collaborate with CCF contract management for resolution of payment issues. Conduct revenue-reporting analysis of costs associated with performing examinations and surgical/medical procedures and recommend fee modifications. Maintain departmental charge master files and perform ongoing reviews of professional and technical charges per compliance guidelines. Administer responsibilities associated with departmental expansion. Assist in practice startup, new service lines and affiliate programs to ensure corporate compliance adherence to capture appropriate revenue. Complete finance accounting and maps revenue of billable services. Conduct research analysis, IDE compliance and billing follow up.

Requirements

High School Diploma/GED
Four years of extensive CPT and ICD 9 CM coding and medical, billing and reimbursement experience
Computer literacy with Microsoft office products with an emphasis on spreadsheets and word processing applications
Knowledge of medical terminology and anatomy/physiology
One of the following certifications is required: Certified Professional Coder (CPC), Certified Coding Specialist Physician (CCS-P), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Associate (CCA) by American Health Information Management Certification (AHIMA)
Understanding of third party and government payer regulations
Experience providing education and trend analysis related to revenue and reimbursement
Manual dexterity to operate office equipment.
Ability to lift and transport up to 15 pounds.
May require extended periods of standing, walking or sitting.
Good visual acuity through normal or corrected vision.
Follows Standard Precautions using personal protective equipment as required for procedures.

Responsibilities

Ensure accountabilities for all services performed and compliance with billing and internal standards is maintained.
Identify opportunities and efficiencies in business office functions and operations.
Manage patient accounts receivable and conducts denial analysis.
Monitor departmental accounts receivable to achieve appropriate reimbursement percentages and maintain financial stability within the department.
Analyze accounts receivable to identify inequities in payment.
Collaborate with CCF contract management for resolution of payment issues.
Conduct revenue-reporting analysis of costs associated with performing examinations and surgical/medical procedures and recommend fee modifications.
Maintain departmental charge master files and perform ongoing reviews of professional and technical charges per compliance guidelines.
Administer responsibilities associated with departmental expansion.
Assist in practice startup, new service lines and affiliate programs to ensure corporate compliance adherence to capture appropriate revenue.
Complete finance accounting and maps revenue of billable services.
Conduct research analysis, IDE compliance and billing follow up.