Claims Escalation Analyst (Full Time)

Description of 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.

Supervision

Reports directly to the Collection Supervisor

Responsibilities and Duties

• 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.

Educational and Work Experience 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.

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.