Payer Resolution Specialist - Denials

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 TitlePayer Resolution Specialist - Denials

LocationCleveland

FacilityRemote Location

DepartmentRCM Payor Denial Mgmt-Finance

Job CodeT24532

ShiftDays

Schedule8:00am-4:30pm

Job Summary

Job Details

Join the Cleveland Clinic team where you will work alongside passionate caregivers and make a lasting, meaningful impact on patient care. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world.  

As a Payor Contract Specialist of Denials, you will collect and assimilate managed care contract information to support contract implementation, compliance monitoring, operations and customer service functions. In this role, you will disseminate information to provider organizations, facilities and operational areas while recommending resolutions to claim payment, reimbursement and related issues. 

A caregiver in this position works remotely (OH based) from 8:00AM - 4:30PM

A caregiver who excels in this role will:  

• Act as an internal resource to community hospitals, institutes, and all other internal departments. 
• Provide contract specific information and resolution of issues to payor and internal customers. 
• Research and track issues including claim payment, reimbursement, operational issues and general information requests. 
• Manage and track escalated and high profile and or highly complex issues. 
• Make recommendations to resolve issues. 
• Negotiate case-specific agreements with local, regional, national and international payors for tertiary referrals and negotiate agreements for other services and CCHS facilities. 
• Gather, research and distribute contract related information for compilation and communication. 
• Prepare communications, summary sheets, quick reference guides and implementation checklists for assigned payor contracts. 
• Prepare material for Managed Care newsletter and web sites.  
• Coordinate informational sessions for payor contract implementation or education. 
• Arrange and facilitate meetings with payor representatives for contract maintenance or problem resolution. 

Minimum qualifications for the ideal future caregiver include:  

• Bachelor's Degree in Business, Marketing, Healthcare or a related field OR High School Diploma/GED and three years of related experience 
• Strong desktop computer skills (Word, Excel, Access, PowerPoint, Outlook) 
• Experience with insurance payer policies and revenue cycles

Preferred qualifications for the ideal future caregiver include:  

• One year of managed care or provider relations experience 

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/      

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 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 offers of employment are follwed by testing for controlled substances 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