Claims Escalation Analyst (Full Time)

Lake Charles Memorial Hospital-posted about 1 month ago
Full-time • Entry Level
Lake Charles, LA
1,001-5,000 employees
Hospitals
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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.

  • Analyze and interpret policy language, contracts and statutes
  • Maintain accurate records of all claims and ensuring timely resolution
  • 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, deductibles & coinsurance 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 escalate 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.
  • Able to write clearly and informatively.
  • 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.
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