Escalation Specialist - Revenue Cycle

Note: Office for this position is located at our Houston Methodist Continuing Care Hospital: 701 S. Fry Rd. Katy, TX 77450.

• This is Monday-Friday opportunity (on site)
• Five years of previous call center and hospital/physician revenue cycle experience

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.

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.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION

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

WORK EXPERIENCE

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