Employee Health Plan (EHP) Specialist I

Cleveland Clinic; Cleveland (OH); Remote; USD 22,000 - 30,000; Full time

Job summary

The Cleveland Clinic is seeking an EHP Specialist I to support patient-first healthcare from a remote location in the NEO area, Monday through Friday, 8:00 a.m. - 4:30 p.m.

On hire, training will be six weeks onsite at CCAC to ensure understanding of EHP benefits, billing, and Healthy Choice programs. The role requires handling calls, inquiries, and documentation across multiple systems (Workday, Epic, SharePoint) and delivering accurate, timely solutions while maintaining compliance with EHP

Qualifications

• High School Diploma or GED required.
• 2 years in health insurance claims processing or customer service required.
• Or 3 years of relevant customer service experience.
• Proficient PC skills.
• Basic understanding of COB, Willis dependent audit and Cobra process.
• Ability to work in a remote/work-from-home environment.

Responsibilities

• Provide customer service for the EHP benefits, eligibility, and the Healthy Choice premium discount program.
• Answer incoming calls and document interactions in a timely fashion.
• Use systems (Workday, Epic, Core, SharePoint, TPA systems) to resolve issues.
• Collect payments and ensure correct posting.
• Refer members to correct HR areas for changes.
• Complete regular audits in the Healthy Choice database.
• Handle EHP Medical Management communications.
• Assist with prior authorizations and medical necessity—requirements by using resources.
• Perform other duties as assigned by EHP Medical Management Supervisor.

Skills

Customer service

Phone support

PC skills

Remote work

Billing knowledge

Education

High school diploma or GED

Tools

Epic

Workday

Core

SharePoint

TPA systems

Healthy Choice Portal

Job description

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.

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. 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. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic's benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).