Employee Health Plan (EHP) Specialist I

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. Job Title Employee Health Plan (EHP) Specialist I Location Cleveland Facility Remote Location Department Employee Health Plan-Caregiver Office Job Code B99933 Shift Days Schedule 8:00am-4:30pm Job Summary Job Details 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. As an EHP Specialist I, you will perform responsibilities which include, but are not limited to: call center customer service, Employee Health Plan (EHP) benefits, billing inquiries, and Healthy Choice programs. A caregiver in this role works remotely in NEO, Monday through Friday, from 8:00 a.m. – 4:30 p.m. Caregivers in this position are required to complete onsite training upon hire. Training will be 6 weeks onsite at CCAC. A caregiver who excels in this role will: Provide customer service for the EHP health insurance benefits, eligibility, and the Healthy Choice premium discount program. Be responsible for answering incoming phone calls, responding to correspondences from EHP members, providers, vendors, and internal departments; document interactions in a timely fashion. Utilize Workday, Core, Epic, SharePoint, Third Party Administrators (TPA) system(s), Healthy Choice Portal, and all associated databases to assist with resolution of issues related to registration, insurance company authorization requirements, billing, insurance company explanation of benefits, provider-based billing, claim processing, coding, and collections. Collect payments and ensure that the dollar amount is posted to the correct debit and according to the patient request. Identify issue(s) in a timely, accurate, and efficient manner and resolve or refer to appropriate staff for resolution. Apply appropriate knowledge of the EHP programs, which include multiple provider networks and medical/pharmacy benefit designs. Refer members to correct area for dental, vision, life event changes, and other Human Resources related issues. Research and complete account work as assigned. Adhere to all the EHP policies and procedures. Attend required training, as assigned. Perform other duties as assigned by EHP management. Complete regular audits in the Healthy Choice database. Perform appeal process for members in Healthy Choice. Answer EHP Medical Management Department communications via multi line telephone and emails to respond to members/providers of 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 by utilizing the EHP website, policies, and databases. Advise members about general Healthy Choice and Coordinated Care program topics. Initiate Healthy Choice enrollment cases received by phone or database in Healthy Planet and initiate Healthy Choice diagnosis/premium appeals on member’s behalf. Perform other duties as assigned by EHP Medical Management Supervisor. Minimum qualifications for the ideal future caregiver include: High School Diploma/GED Two years in health insurance claims processing, customer service, collection call center or medical facility is required OR must possess a minimum of three years of 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 r Demonstrated PC skills proficiency Basic understanding of Coordination of Benefits, Willis dependent audit and Cobra process Basic understanding of how to interpret an Explanation of Benefits statement, claim payment and/or denial Efficiently utilize multiple systems and the necessary databases/programs to perform tasks, as assigned, within expected timeframes Ability to work with minimal supervision in a remote/work from home environment Preferred qualifications for the ideal future caregiver include: Formal office training (Microsoft Office) Experience working in Epic Knowledge of provider networks Knowledge of Epic or Medical Record System Patient access representative or Finance Billing experience Physical Requirements: Ability to sit for prolonged periods of time. Ability to work and move among all locations of the EHP Administrative Office. Excellent hand/eye coordination. Manual dexterity to operate personal computers and standard office machines. Visual acuity, hearing and speaking to transfer information from paper to computer, from computer to computer, and to communicate in person and on the telephone. Ability to work in general office working conditions. Good written and verbal communication skills required. Personal Protective Equipment: Follows standard precautions using personal protective equipment as required. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. 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 Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: Please review the Equal Employment Opportunity poster . Cleveland Clinic is pleased to be an equal employment opportunity employer.