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 MondayFriday 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 Specialists primary role is to facilitate resolution to elevated issues that may require indepth research and analysis to resolve. This position also provides feedback to other customer service team members and management to create educational opportunities for improvement.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental Scope of Service and Provision of Care plans as applicable for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional ethical physical and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth dignity and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET Managing Up Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees experiential journeys to ensure strong communication ease of access to information and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organizations vision fulfills the mission and abides by the I CARE values

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 allinclusive; 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 postsecondary education etc.

WORK EXPERIENCE

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

LICENSES AND CERTIFICATIONS REQUIRED

• N/A

KNOWLEDGE SKILLS AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job determined through ongoing 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 coworkers 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 multitask 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

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

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

ONCALL*
*Note that employees may be required to be oncall 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

Houston Methodist (HM) is one of the nations leading health systems and academic medical centers. HM consists of eight hospitals: Houston Methodist Hospital its flagship academic hospital in the heart of the Texas Medical Center and seven community hospitals throughout the greater Houston metropolitan area. HM also includes an academic institute a comprehensive residency program a global business division numerous physician practices and several freestanding emergency rooms and outpatient facilities. Overall HM employs over 25000 employees. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

In 2019 Houston Methodist and its physicians treat more than 6333 international patients from more than 76 countries. Houston Methodist Global Health Care Services consulting and education divisions also provide advisory services and training and development to health care organizations around the world.