Escalation Specialist

At Houston Methodist, the Escalation Specialist position is responsible for acting as a liaison between the patient and the hospital, the Physician Organization (PO) and/or payers for billing related matters. The Escalation Specialist's primary role is to facilitate resolution to elevated issues that may require in-depth research and analysis to resolve. This position also provides feedback to other customer service team members and management to create educational opportunities for improvement.

The Escalation Specialist will be part of a monthly rotation twice a year. All other times they will act as a liaison between Houston Methodist, patients, providers, and payers for all post-care matters related to account resolution. This position interacts with all SBO sub-units and other hospital and Physician Organization service areas on a daily basis, cultivating good business relationships to promote harmony and effective communication to resolve patient concerns post care. This role will handle more complex inquiries and assists management. They will be responsible for identifying trends impacting performance and will providing innovative suggestions for process improvement. This role handles an average of 75-100 inbound calls daily, while maintaining professionalism, accuracy and patient satisfaction.

FLSA STATUS
Non-exempt

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Five years of previous call center and hospital revenue cycle experience

SKILLS AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Working knowledge of the patient billing cycle for both hospital and professional billing
• Excellent customer service and professional communication skills with the ability to remain calm in stressful situations
• Knowledge of medical terminology and applicability
• Excellent spelling/grammar skills
• Managed care knowledge with the ability to differentiate between insurance plans such as PPO, POS, HMO, etc.
• Ability to multi-task and flexibility to meet the requirements of the department and the organization
• Ability to problem solve in the moment and provide recommendations in alignment with values
• Proficient computer skills and ability to learn and navigate multiple software programs
• Strong training, leadership and mentoring skills
• Ability to analyze data elements and identify trends
• Bilingual skills preferred

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results.
• Follows the standard talking points outlined in department protocols when interacting with patients to ensure high quality and consistent service.
• Works collaboratively with all necessary internal and external stakeholders to ensure resolution of escalated patient issues and concerns.

SERVICE ESSENTIAL FUNCTIONS

• Serves as the final level of customer service issue resolution. Provides resolution within the service level agreement guidelines according to department policies and procedures.
• Compiles and summarizes data, identifies trends, provides reports to management, and communicates feedback to customer service team members to improve the patient experience.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Utilizes sound judgment and analytical skills to bring the account for resolution, analyzing the data elements (clinical and financial) within the electronic health record to determine the current state of the account.
• Provides clear and concise documentation of every action taken on an account in the system collection notes. Provides balance breakdown to document the status of next responsible party (i.e., primary, secondary payor, patient balance, or credit balance).
• Meets or exceeds stated Performance Indicator Expectations (e.g., productivity, quality review, abandonment rate, adherence expectations).
• Consistently takes the necessary steps to ensure that protected health information remains private and confidential, according to established Health Insurance Portability and Accountability Act (HIPAA) guidelines.

FINANCE ESSENTIAL FUNCTIONS

• Follows levels of authority for posting adjustments, refunds, and contractual allowance. When necessary, obtains management approval for discounts above standard procedures.
• Uses resources effectively and efficiently. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Stays current on collection procedures of various payors and industry trends. Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development (i.e., participates in training opportunities, focal point review activity, etc.). Applies new learning.
• Generates and communicates new ideas and suggestions that will improve quality or service.
• Employs creativity and adapts rapidly to changing conditions during interactions with patients.

SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (department approved): Yes

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Five years of previous call center and hospital revenue cycle experience