Claims Escalations Analyst

Lake Charles Memorial Hospital; Lake Charles, Northern (LA, KY); Hybrid; USD 42,000 - 62,000; Full time

Job summary

Lake Charles Memorial Hospital is seeking a Claims Escalation Analyst to manage liability claims from start to finish. You will verify information, determine reimbursement eligibility, reconcile estimates, and negotiate payments with carriers and involved parties.

The role requires strong organizational and communication skills and familiarity with healthcare billing processes. The position reports to the Office Manager and involves collaboration with multiple departments to resolve issues and

Qualifications

• High school diploma or GED required.
• At least 1 year experience in healthcare or related field preferred.
• Adequate keyboarding skills (40 words per minute).
• Strong organizational and communication skills, including ability to discuss medical issues.
• Negotiation skills and proactive problem solving.

Responsibilities

• Monitors liability claims from start to finish, verifying and updating information.
• Reviews policy to determine charges eligible for reimbursement.
• Reconciles a claims adjuster's estimates and negotiates payment.
• Follows up to ensure payments are made and properly posted.
• Interacts with carriers and departments to resolve outstanding issues.
• Prioritizes work and documents information using standardized methods.
• Maintains productivity standards and meets deadlines.

Skills

Communication skills

Negotiation

Typing 40 wpm

Attention to detail

Healthcare knowledge

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.

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 or 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.
• Vary 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.