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.
