RCCEM Escalation Manager, Enhanced Claim Resolution Management

Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

Position Summary:

Join our dynamic Revenue Cycle Case and Escalation Management (RCCEM) team, where you will play a pivotal role in tackling our most complex and sensitive client issues. As the final escalation point, our team is dedicated to researching and resolving challenges that require a keen eye for detail and a commitment to excellence.

You will be at the forefront of driving actionable insights across Product and Revenue Cycle Management, ensuring that our product and services not only meet but exceed athenahealth's value proposition and the expectations of our clients. Your contributions will be essential in creating visibility into case performance, fostering consistency in terminology and measurement, and championing initiatives that enhance case resolution performance.

As an Escalation Manager, you will manage your own book of business while also supporting the team by collaborating with peers to identify and eliminate barriers to resolution and assist them in navigating high-profile escalations. You will help maintain queue health, provide tools for better management and monitoring, and leverage case data to gather and deliver actionable insights to our partner teams.

At athenahealth, we pride ourselves on our innovative spirit and solution-oriented mindset. We thrive in a collaborative environment that embraces continual change and improvement, fueled by our rapid growth. If you enjoy engaging directly with people and teams, being their partner, advocate, and coach to ensure they have the right tools, relationships and confidence to navigate the evolving landscape of issue management, this is the perfect opportunity for you to make a significant impact. Join us in shaping the future of healthcare solutions!

Essential Functions (Duties and Responsibilities):

Customer Focus

• Models the teams expectations and methodology while supporting and leading the most sensitive engagements.
• Develops and maintains professional and productive ongoing client relationships regarding service related issues.
• Meet with clients and stakeholders weekly, biweekly, monthly, or as necessary to provide senior level escalation engagement updates.
• Leverages strong cross functional partnerships to advocate for changes to service delivery, service offerings and/or product.
• Successfully balances managing individual book of business and supporting others (50/50)

Analytical Thinking

• Develop a comprehensive business case to tell the “impact story” to create a strong sense of client benefit to facilitate effective advocacy
• Lead team initiatives to improve department processes and tools.
• Drives workflow and quality improvements to reduce case inflow and improve client sentiment.
• Utilizes reporting and tools to understand and manage RCCEM book of business.

Plans and Aligns (Project Management)

• Applies comprehensive project management skills to manage project life cycle to ensure top quality deliverables
• Ensures critical resources are aligned and coordinated across different teams.
• Supports the team in anticipating risk and contingencies as part of the planning process.
• Effectively manages the queue by assigning cases according to skill level, account ownership, and ensuring a balanced workload.

Lead Others

• Provide leadership in escalation and project management.
• Foster team development by enhancing skills in content knowledge, de-escalation strategies, resource utilization, and creating actionable insights.
• Work collaboratively with the Senior Manager on team performance and development opportunities.

Education & Experience Required:

• An ideal candidate will have medical billing/US healthcare experience or have demonstrated the ability to rapidly learn the foundational concepts of US healthcare and medical billing.
• Bachelor's degree or equivalent experience

Knowledge & Skills:

• Customer-centric mindset characterized by empathy, collaboration, and advocacy.
• Strong written and verbal communication skills, enabling effective interaction with all organization level and stakeholders.
• Expertise in problem-solving, with the ability to analyze large data sets to identify root causes and trends.
• Proven capability to analyze data, surface trends and insights, and provide actionable recommendations.
• Ability to work independently and