Account Rep III

Cleveland Clinic Independence , OH 44131

Posted 2 months ago

Job Summary:

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.

Responsibilities:

  • Recommends and provides input to execute customers service programs in accordance with changes in insurance reimbursement regulations and data obtained from various groups.

  • Provides supervisor/manager with information to assist department liaison with various departments in regards to various issues including but not limited to contract and reimbursement rules. Complies, recommends and assists with the implementation of various management reporting systems to insure accurate and timely reporting of department goals and results.

  • Assists with department audits as required. Participates in meetings with various payors, internal billing groups and other CCF 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, recommends 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.

  • Maintains data and develops enhancements to database and other various management reporting systems to insure accurate presentation of trends in payor reimbursement, error rates, and maximize recovery of underpayments.

  • Validates new and existing contracts and reimbursements rules/logic.

  • Other duties as assigned.

Key Job Responsibilities:

  • Performs a forensic analysis to maximize the identification of underpayment trends

  • Establish relationships with Market & Network Services, Contract Management, Financial reporting, Strategic Initiatives and other areas

  • Develop knowledge regarding contract language/terms and reimbursement methodologies, for contracted commercial and government payers

  • Identifies payer billing, remit and claim processing discrepancies

  • Work underpayment variance inventory from EPIC work queues

  • Gain a solid understanding of various CCHS systems

  • Must have good verbal, written and organizational skills.

  • Interact well with team-members

  • Other duties as assigned

Education:

  • High School Diploma or GED required.

  • An Associate's Degree may offset one year of required experience.

  • A Bachelor's Degree may offset two years of the required experience.

Certifications:

  • None required.

Complexity of Work:

  • Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

  • Must be able to work in a stressful environment and take appropriate action.

Work Experience:

  • Minimum of three years patient accounting experience.

  • An Associate's Degree may offset one year of required experience.

  • A Bachelor's Degree may offset 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 function 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.

Preferred Work Experience:

  • Basic Medical Terminology Knowledge

  • MS Excel Skillset - Intermediate User

  • EPIC Knowledge Base

  • Familiar with 835 (Remit) and 837 (Claims)

  • Familiar with payment methodologies

Physical Requirements:

  • Manual dexterity to operate office equipment.

  • May require periods of sitting, standing and the ability to walk to various locations throughout the Foundation to attend meetings; must have normal or correction vision to clearly communicate verbally by phone or in person.

Personal Protective Equipment:

  • Follows standard precautions using personal protective equipment as required.

Keywords: Contract Management, EPIC, commercial payers, government payers, Remit (835), Claims (837), healthcare payment methodologies

#LI-MH1

The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic's Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.

Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities


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