Escalation Specialist

Job Title: Escalation Specialist              

Exempt Status: Non-Exempt

Division: MRR                           

Reports to: Escalations Supervisor

Location: Gardena, CA

 

Episource, with over 3,000 employees worldwide, is a leading provider of risk adjustment services and solutions for health plans.  Our services help Medicare Advantage, Commercial/Exchange, and Medicaid managed care plans improve and support accurate reimbursement in a post-Affordable Care Act market. Our services include retrospective chart reviews, medical record retrieval, HEDIS/ACO quality reporting, and data analytics, allowing payers and providers to dramatically reduce costs and improve quality of care.

Job Summary:

The Outreach Escalation Specialist is responsible for a number of tasks which include but is not limited to escalations. Will be required to manage high priority provider offices and hospitals.  May be required to collaborate with multiple department specialists.  Daily work responsibilities will consist of efficiently scheduling chart retrieval as well as de-escalating complaints and manage special tasks in a project based, call center environment.

Responsibilities:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

  • Responsible for scheduling and coordinating medical record requests.
  • Required to manage escalations and high priority tasks.
  • May be specializing as a subject matter expert in specific areas.
  • Follows-through from beginning to end to ensure completion of project-specific tasks.
  • Responsible for contacting and scheduling provider offices for medical record retrieval which typically have specific needs or are considered high-risk.
  • Required to have excellent verbal and written communication.
  • Expected to have strong understanding of Outreach Department policies and protocol.
  • Support call center operations by handling inbound and outbound calls as well as specialized matters.
  • Specializes in project-specific details which may include documenting and cascading updates to the call center team.
  • Is flexible and trainable to perform additional special assignments as required per project.
  • May be required to support various project tasks based on business needs.
  • Requires an individual to maintain the ability to work in an environment with PHI / PII data.
  • May be assigned other duties.
  • Must maintain compliance with all company policies and procedures.

Education / Requirements:

  • Bachelor’s degree preferred and/or equivalent to job related experience.
  • Strong customer service and office/administrative experience skills to comprehend a variety of activities associated with a team-oriented environment.
  • Basic understanding of medical terminology and handling healthcare documentation confidentially. (i.e. HIPAA and PHI)
  • Strong computer skills in Microsoft Suite as well as intermediate experience using Excel.
  • Possess excellent written, verbal, and interpersonal communication skills, and the ability to problem solve and manage data with great attention to detail.
  • Must have excellent time management skills, be highly organized, self-motivated, and able to work under project based, deadline-oriented formats with minimal day-to-day supervision.

Physical Requirements:

  • Must be able to lift and carry up to 30 lbs.
  • Frequent standing, walking, sitting.
  • Some bending, stooping and stretching, eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
  • Requires normal range of hearing and eyesight.

EEO POLICY STATEMENT:

Episource, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Episource, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training.

Episource, LLC expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Episource, LLC employees to perform their expected job duties is absolutely not tolerated.