Remote opportunity-Ohio Resident

*In office once per week-CCAC at Beachwood*

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.    

The Billing Specialist I perform billing functions to support the Retail/ Specialty Pharmacy. This role research, analyze and reconcile patient account receivables, refunds, claims processing, patient statements, and revenue cycle functions. 

A caregiver in this position works Days, 8:00am—4:30pm. 

A caregiver who excels in this role will:  

• Review and research entered claims, assist with adjudication, work, and resolve unpaid claims, generate patient statements, and maintain accounts receivable records. 

• Evaluate accounts and prepare adjustments to refund payments and correct discrepancies, as necessary. 

• Identify and assist patients who may qualify for patient assistance programs or copay assistance. 

• Perform manual and/or electronic processing of claims in a prompt and timely manner. 

• Maintain and apply knowledge of current requirements relative to managed care contracts, Medicare, Medicaid, and departmental policies regarding timely filing of claims. 

• Address insurance, reimbursement, and payment issues as appropriate by communicating with insurance, providers, patients, and pharmacists. 

• Prepare manual/electronic claims and submit with appropriate documentation. 

• Verify benefits and eligibility and submit prior authorizations as needed. 

• Maintain accurate records of outstanding claims and/or past due balances. 

• Communicate with Reimbursement Manager and/or Finance Director regarding accounts receivable discrepancies. 

• Participate and support department initiatives, meetings, and training of staff. 

Minimum qualifications for the ideal future caregiver include:  

• High school diploma or equivalent. 

• One year of related experience involved with billing functions in a pharmacy environment such as a retail, specialty, or home delivery pharmacy. 

Preferred qualifications for the ideal future caregiver include:  

• Associate’s degree in accounting, healthcare, or related field. 

• Certified Pharmacy Technician Certification (CPTH). 

• Knowledge of billing codes for outpatient pharmacy charges, (NDC, HCPCS, CPT, J-codes, ICD-10) codes and formal documents necessary for billing (i.e. UB04, CMS-1500, EOB). 

• Knowledge of billing requirements and reimbursement guidelines for Medicare (Part B and Part D), Medicaid and commercial insurance payers. 

• Familiarity with medical and pharmacy terminology and knowledge of basic accounting functions.  

• Strong written and verbal communication skills. 

• General knowledge of spreadsheets, computer billing software and payer websites/portals. 

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/