Account Representative III

Account Representative III

Remote Location

Full time

219669

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: Account Representative III

Location: Cleveland

Facility: Remote Location

Department: RCM Special Billing-Finance

Job Code: U18025

Shift: Days

Schedule: 8:00am-4:30pm

Job Summary

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as the No. 4 hospital in the nation, according to the U.S. News & World Report. At Cleveland Clinic, you will work alongside passionate and 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 Account Representative III, you will perform a specific operational responsibility within a revenue cycle management functional unit including customer service, insurance billing and follow-up processes for commercial and government payers, insurance verification, cash application, credit balance resolution, and/or account reconciliation.
The ideal future caregiver is someone who:

• Is engaged with their job responsibilities.
• Thrives working both independently and as part of a team.
• Acts in a professional, caring, and helpful manner.
• Is an effective communicator.

By taking this opportunity, you’ll have the opportunity to learn and develop within the team as well as advance your career into positions such as CSR I, II, III, Work Leader, and more.
At Cleveland Clinic, we know what matters most. That’s why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you’ll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you’ll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Job Details

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.

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.

Physical Requirements:

• Ability to communicate and exchange accurate information.
• Ability to perform work in a stationary position for extended periods.
• Ability to work with physical records or operate a computer or other office equipment.
• In some locations, ability to travel throughout the hospital system.
• In some locations ability to move up to 25 lbs.

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 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 Health System’s Smoking Policy will be permitted to reapply for open positions after 90 days.

Cleveland Clinic Health System administers an influenza prevention program as well as a COVID-19 vaccine program. You will be required to comply with both programs, which will include obtaining an influenza vaccination on an annual basis, and being fully vaccinated against COVID-19, 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.