CBO Claims Escalation Analyst (Full Time)

DESCRIPTION OF POSITION:

Claims Analyst analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Reviews claims for eligibility to be reimbursed. The Claims Analyst maintains updated records and prepares required documentation. Assists in controlling the cost of processing claims.

RESPONSIBILITIES AND DUTIES:

Consistently monitors assignment to ensure that all steps necessary to assist the Team with achieving its goals have been taken.

Documents all information in the System following the Clear Concise Consistent method.

Appropriately prioritizes work queue in order to work highest priority first based on assigned subjects.

Properly utilizes productivity tracking mechanisms.

Works at or above the weekly set productivity standard and completes tasks in a timely manner.

Accurately analyzes, corrects and releases assigned claims daily.

Consistently makes appropriate decisions on what hold codes are appropriate and follows the appropriate process for notification to the responsible area.

Works with other departments to resolve any outstanding billing deficiencies.

Consistently analyzes and communicates with leadership and responsible areas on held claims to ensure that all claims are released timely.

Maintains assigned task by ensuring that the task is completed timely.

Ability to evaluate a difficult billing problem and find the resolution.

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.

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.