Claims Escalation Analyst

Lake Charles Memorial Health System; Lake Charles (LA); Vor Ort; USD 42.000 - 64.000; Vollzeit

Zusammenfassung

Lake Charles Memorial Health System is seeking a Claims Escalation Analyst to oversee liability claims from start to finish, verify information, review policies for reimbursements, reconcile estimates, negotiate payments, and ensure timely settlements.

The role reports to the Office Manager and emphasizes accuracy, negotiation, and cross-department collaboration in a busy healthcare environment.

Qualifikationen

• High school diploma or GED required.
• At least 1 year in healthcare or related field preferred.
• Adequate keyboarding skills (40 WPM).
• Strong organizational and communication abilities, including discussing medical issues.
• Negotiation skills and proactive approach.

Aufgaben

• Understands payers allowable calculations to preview an account and identify payment errors.
• Accurately posts transactions, ensuring correct keying for payments, adjustments, deductions, and coins.
• Evaluates accounts to ensure payments and adjustments are appropriate.
• Resolves outstanding issues delaying claims processing with other departments.
• Communicates with assigned payer and escalates/pushes claims with carriers and departments.
• Evaluates accounts to determine what is needed to resolve quickly.
• Uses productivity tracking mechanisms to monitor performance.
• Prioritizes work queue to address highest-priority items first.
• Documents information in the system using Clear Concise Consistent method.
• Monitors assignments to help the team achieve goals.
• Writes clearly and informatively; edits for spelling and grammar; adapts writing style as needed.

Kenntnisse

Organizational skills

Communication skills

Negotiation

Attention to detail

Typing speed 40 WPM

Ausbildung

High school diploma or GED

1 year experience in healthcare or related field preferred

Basic computer skills

Jobbeschreibung

• The claims escalation analyst monitors liability claims from start to finish, verifying and updating information on submitted claims, reviewing the policy to determine which charges are eligible for reimbursement, reconciling a claims adjuster's estimates, negotiating payment to all parties and following up to ensure that payments are made.

Description Of Position

• The claims escalation analyst monitors liability claims from start to finish, verifying and updating information on submitted claims, reviewing the policy to determine which charges are eligible for reimbursement, reconciling a claims adjuster's estimates, negotiating payment to all parties and following up to ensure that payments are made.

SUPERVISION:

Reports directly to the Office Manager

Responsibilities And Duties

• Understands assigned payers allowable calculations in order to preview an account to determine if properly paid and identify when errors are made in payments.
• Accurately posts transactions based on assigned duties ensuring that keying is correct for all payments, adjustments, ded & coins assignments.
• Able to evaluate transactions posted on an account to ensure all payments and adjustments are posted and are appropriate.
• Works with other departments to resolve any outstanding issues delaying claims processing.
• Communicates effectively with assigned payer and makes appropriate decisions to escalates and push claims with carriers, companies and other departments.
• Accurately evaluates each account in order to determine what is needed, what is left outstanding and what steps are necessary to resolve the account quickly.
• Properly utilizes productivity tracking mechanisms.
• Works at or above the weekly set productivity standard and completes tasks in a timely manner.
• Appropriately prioritizes work queue in order to work highest priority first based on assigned subjects.
• Documents all information in the System following the Clear Concise Consistent method.
• Consistently monitors assignment to ensure that all steps necessary to assist the Team with achieving its goals have been taken.
• Writes clearly and informatively.
• Edits work for spelling and grammar.
• Varies writing style to meet needs.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Education And Work Experience

• High school graduate or GED certificate, required.
• At least one year experience in Healthcare or related field preferred.
• Adequate keyboarding skills( 40 words per minute typing rate); Basic computer skills.
• Strong organizational and communication skills, including ability to discuss medical issues.
• Negotiation skills including assertiveness and being proactive.

Physical Demands/Work Environment

• Work requires light duty lifting.
• Must be able to remain in a stationary position 50% of the time.
• Constantly operates a computer and other office machinery such as calculator, copy machine, and computer printer.
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.