Escalation Specialist - Revenue Cycle FT-Katy

Overview

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.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer 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 organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

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.). A