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Overview:
Job Summary:
- The Escalation Specialist is responsible for responding to and handling complaints and escalations from patients and clients as it relates to account balances and payments. They must seek ways to determine appropriate courses of action, conduct investigative steps to resolve issues, and communicate with their manager promptly for updates and resolution of such escalations. They are also responsible for completing special projects for escalated clients per the advisory of their manager and must maintain the deadline provided for given projects. The Escalation Specialist will be expected to perform all payment posting activities within the company systems and assist the department in day-to-day posting duties. The Escalation Specialist is also responsible for identifying and keeping the Posting manager up to date with coaching opportunities for Posting specialist based on their findings.
Essential Functions and Tasks:
- Research any missing payment such as EOB’s, check information, or payment information using account information, insurance websites, and contacting insurance if necessary.
- Resolve all escalated accounts within 24 hours.
- Extensively investigate whether payments stemming from pt complaints have been posted anywhere in CB outside of the patient’s accounts.
- Analyzing historical data to identify the root cause of the client/patient escalation.
- Timely handling of clarifications from overseas team across both legacy and CB systems.
- Posts Accounts Payable deposits.
- Processes electronic 835’s and manual payer EOBs, including the posting of insurance allowable, patient portions, denials, adjustments, contractual allowances, recoups, and forward balancing.
- Interprets Explanation of Benefits (EOB) remittance codes and applies correct denial codes.
- Balances and closes payment batches timely.
- Maintain open lines of communication by reporting coaching opportunities directly to Posting Managers as needed by email communications in a detailed, concise, and timely manner.
- Performs special projects and other duties as assigned.
Education and Experience Requirements:
- High School Diploma or GED
- At least six (6) years of Cash Posting experience
Knowledge, Skills, and Abilities:
- Professional, accurate, clear, and concise written and verbal communication
- Attention to detail
- Positive and encouraging attitude
- Average QA score of 90% or higher for past 90 days
- Excellent time and attendance (not on attendance counseling)
- Not on any form of disciplinary action
- Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately
- Ability to remain flexible and work within a collaborative and fast paced environment
- Ability to communicate with diverse personalities in a tactful, mature, and professional manner
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