EHP Specialist I

Location

Remote | United States

Job description

req#: 246922

Location: Remote

Facilities: Remote Location ,

Professional Area: Human Resources

Department: 4308 Employee Health Plan-Caregiver Office

Job Code: B99933

Schedule: Full Time

Shift: Days

**This position requires you to train on site in Beachwood, OH for 2 months, qualified applicants must reside near Cleveland, OH**

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. 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 EHP Specialist I,  you will have the opportunity to use your Customer Service Skills to assist Cleveland Clinic Caregivers with their questions regarding billing, Health Choice and Benefits.  You will become a subject matter expert in Cleveland Clinic benefit programs. Responsibilities will include, but are not limited to: customer service, eligibility process, knowledge of Employee Health Plan (EHP) benefits and Healthy Choice/Coordinated Care programs, and researching and resolving accounts and/or prior-authorizations issues.

The ideal future caregiver is someone who: 

• Has strong customer service, organizational, and communication skills. 

• Can multitask in a stressful situation.  

• Works well in a close-knit, teambuilding environment.  

• Can make decisive judgement under minimal supervision. 

• Has a basic understanding of Coordination of Benefits, Willis dependent audit, Explanation of Benefits, claims payment or denial, and Cobra processes. 

This is an excellent opportunity for those who are flexible and would like to advance their career growth opportunities within Cleveland Clinic. Training for this position will be onsite at the Cleveland Clinic Administrative Campus, then move to remote positions. Caregivers in this role will have the opportunity to work in vertical growth positions, such as Coordinator, 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.

Responsibilities:

• Responsible for answering incoming phone calls, responding to emails and cases from EHP members, providers, vendors and internal departments. Responsible for documenting interactions in a timely fashion.
• Identifies issue(s) in a timely, accurate and efficient manner and resolves or refers to appropriate staff for resolution.
• Applies appropriate knowledge of the EHP programs, which includes multiple provider networks and medical/pharmacy benefit designs.  
• Refers members to correct area for dental, vision, life event changes and other Human Resources related issues.
• Adheres to all the EHP policies and procedures.
• Attends required training, as assigned.
• Other duties as assigned.

Non Clinical Responsibilities:

• Provides overall customer service for the EHP health insurance benefits, wellness programs, and the Healthy Choice premium discount program.
• Utilizes Workday, Core, Epic, and Third Party Administrators (TPA) system(s), Healthy Choice Portal and all associated databases to assist with resolution of issues.
• Applies internal policy for eligibility process and provides accurate information. Researches to resolve eligibility issues, if necessary.
• Performs other duties as assigned by EHP management.

Clinical Responsibilities:

• Answers 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.
• Advises members/providers of provider network and prior-authorization/post service medical necessity requirements by utilizing the EHP website, policies, and databases.
• Advises 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.
• Performs other duties as assigned by EHP Medical Management Supervisor.

Education:

• High School diploma required.

Certifications:

• None required.

Complexity of Work:

• Basic understanding of Coordination of Benefits, Willis dependent audit and Cobra process.
• Basic understanding of how to interpret an Explanation of Benefits statement and claim payment and/or denial.
• Requires excellent customer service, organizational, critical thinking, decisive judgment, and communication skills.
• Must be able to handle multiple tasks, be able to work in a stressful environment, and take appropriate actions as needed.
• Must follow hospital and departmental policies and procedures at all times.
• Knowledge of provider networks preferred.
• Efficiently utilize multiple systems and the necessary databases/programs to perform tasks, as assigned, within expected timeframes
• Experience working in Epic preferred.
• Ability to work with minimal supervision in a remote/ work from home environment.

Work Experience:

• Previous customer service experience preferred.
• Some formal office training preferred, to include Microsoft Office software.

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.

Pay Range

Minimum hourly: $15.75

Maximum hourly: $21.65

The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic’s benefits package, which includes among other benefits, healthcare/dental/vision and retirement.

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 tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. All new caregivers must clear a nicotine test within their 90-day new hire period. Candidates for employment who are impacted by Cleveland Clinic Health System’s Smoking Policy will be permitted to reapply for open positions after one year.
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.

Please review the Equal Employment Opportunity poster

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

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