Claims Escalation Analyst (Full Time)

Lake Charles Memorial Health System

Date: 2 days ago
City: Lake Charles, Louisiana
Contract type: Full time
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 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.
  • 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.

“Experience Memorial” is more than a slogan, it’s the care we provide our patients and it’s the commitment to our community and our team members. As a nationally certified Great Place to Work, at Lake Charles Memorial Health System you will have the opportunity to be a part of an organizational culture that supports not only exceptional patient care but also the well-being and professional growth of our employees. Join us and be a part of a team where your contributions are valued, your growth is nurtured, and your success is celebrated.

Working at Lake Charles Memorial Health System | Great Place To Work
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