What are the responsibilities and job description for the Escalation Specialist position at Houston Methodist?

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

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

ON-CALL*

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

TRAVEL**

**Travel specifications may vary by department**

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Escalation Specialist