Claims Escalations Analyst

Lake Charles Memorial Health System; Lake Charles (LA); On-site; USD 42,000 - 68,000; Full time

Job summary

Lake Charles Memorial Health System in Lake Charles, LA seeks a Claims Escalation Analyst to manage liability claims from start to finish, verify information, review policies for reimbursable charges, reconcile estimates, negotiate payments, and follow up to ensure payments are made.

The role emphasizes accuracy in posting transactions, collaboration with payers and departments, and meeting productivity standards while documenting clearly in the system.

Qualifications

• High school diploma or GED required.
• At least one year experience in healthcare or related field preferred.
• Ability to keyboard at 40 words per minute and basic computer skills.
• Strong organizational and communication skills, including ability to discuss medical issues.
• Negotiation skills including assertiveness and being proactive.

Responsibilities

• Monitors liability claims from start to finish and verifies information.
• Reviews policies to determine reimbursable charges and reconciles estimates.
• Negotiates payments and follows up to ensure payments are made.
• Posts transactions accurately and ensures correct keying for payments and adjustments.
• Collaborates with other departments to resolve issues delaying claims processing.
• Communicates with assigned payer and escalates claims with carriers and other departments.
• Evaluates accounts to determine needs and steps to resolve quickly.
• Documents all information in the system using Clear Concise Consistent method.
• Maintains productivity standards and prioritizes high-priority work.

Skills

Communication skills

Organizational skills

Negotiation

Typing 40 wpm

Computer literacy

Education

High school diploma or GED

Job description

• 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 elevate 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.