Clearinghouse Claims Analyst at ChristianaCare
Wilmington, DE
About the Job
PRIMARY FUNCTION:
The Clearinghouse Claims Analyst is responsible for managing the inventory within the clearinghouses by ensuring issues are resolved or reported to the vendors and claims are billed in a timely manner according to state, federal and other third-party payer billing and reimbursement guidelines. Completes necessary paperwork for EFT/ERA enrollment.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Reviews inventory in clearinghouses daily to ensure all claims have been exported except for those with a valid hold reason. Notifies Billing Managers when outliers are discovered.
Identifies new errors and reviews with the Billing Managers to determine if updates are needed in the host system or a ticket needs to be opened with the appropriate clearinghouse.
Researches and resolves reported claim errors in a timely manner including the management of tickets with the clearinghouses.
Responsible for mapping payers in the clearinghouses.
Performs daily reconciliation from host system to the clearinghouses.
Collaborates with Billing Managers and IT in a timely manner when needed.
Provides training on the clearinghouses for new users along with refresher training as necessary.
Acts as a system administrator for user issues.
Assigns user logins and resets passwords as needed.
Runs trend analysis reports, analyzes data and reviews results with the Billing Managers.
Performs system maintenance updates as needed.
EDUCATION AND EXPERIENCE REQUIREMENTS:
Bachelor’s degree from an accredited college in a relevant field of study preferred.
Equivalent and relevant combination of education and experience may be considered in lieu of bachelor’s degree.
KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:
Experience with Change Healthcare and Experian preferred.
The ability to recognize claim error trends and communicate immediately to billing managers.
Knowledge of medical terminology including cash posting, EOBs and insurance terminology.
Ability to work independently as well as in a team environment.
Ability to prioritize work and make frequent adjustments to priorities.
Ability to manage multiple concurrent activities.
