Claims Escalation Analyst (Full Time)

Lake Charles Memorial Hospital•Lake Charles, LA

11d•Onsite

About The Position

The Claims Escalation Analyst will be responsible for managing and investigating escalated claims and ensuring timely resolution. The successful candidate must have strong analytical and problem-solving skills, as well as excellent communication skills.

Requirements

High school graduate or GED certificate, required.
Minimum of 1-year experience in Healthcare, preferably in the insurance industry
Proficient in Microsoft Office suite
Analytical and problem-solving skills
Excellent communication and interpersonal skills
Ability to work well in a team environment
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.

Responsibilities

Analyze and interpret policy language, contracts and statutes
Maintain accurate records of all claims and ensuring timely resolution
Understand assigned payer's allowable calculations to preview an account, determine if properly paid, and identify payment errors.
Accurately post transactions (payments, adjustments, deductibles, coinsurance) based on assigned duties, ensuring keying accuracy.
Evaluate posted transactions to ensure all payments and adjustments are appropriate.
Work with other departments to resolve outstanding issues delaying claims processing.
Communicate effectively with assigned payers and make appropriate decisions to escalate and push claims with carriers, companies, and other departments.
Accurately evaluate each account to determine needs, outstanding balances, and necessary steps for quick resolution.
Properly utilize productivity tracking mechanisms.
Work at or above the weekly set productivity standard and complete tasks in a timely manner.
Appropriately prioritize work queue to address highest priority items first based on assigned subjects.
Document all information in the System following the Clear Concise Consistent method.
Consistently monitor assignment to ensure all necessary steps are taken to assist the Team in achieving its goals.
Write clearly and informatively.