Clearinghouse Claims Analyst

3 days ago


Wilmington, United States ChristianaCare Full time

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.



  • Wilmington, United States ChristianaCare Full time

    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...


  • Wilmington, United States ChristianaCare Full time

    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...


  • Wilmington, DE, United States ChristianaCare Full time

    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...


  • Wilmington, United States Chubb Full time

    The Chubb Global Services (CGS) group focuses on delivering superior clients services to Chubb’s multinational business across Chubb’s diverse product line. The CGS Finance group oversees global money movement, billing and collections of reinsurance and deductibles, reporting, and overall multinational guidance and strategy. Reporting Relationship: The...


  • Wilmington, United States Chubb International Full time

    The Chubb Global Services (CGS) group focuses on delivering superior clients services to Chubb’s multinational business across Chubb’s diverse product line. The CGS Finance group oversees global money movement, billing and collections of reinsurance and deductibles, reporting, and overall multinational guidance and strategy. Reporting Relationship: The...


  • Wilmington, Delaware, United States Chubb Full time

    Job SummaryThe Chubb Global Services group is seeking a highly skilled Claims Billing Analyst to join our team. As a key member of our Finance group, you will be responsible for delivering superior client services to Chubb's multinational business across our diverse product line.Key ResponsibilitiesCalculate, bill, and notify insureds and reinsurers of...


  • Wilmington, Delaware, United States Chubb Full time

    The Chubb Global Services group is dedicated to delivering exceptional client services to Chubb's multinational business across a diverse product line. The CGS Finance group oversees global money movement, billing, and collections of reinsurance and deductibles, reporting, and overall multinational guidance and strategy.Key Responsibilities:The analyst is...


  • Wilmington, Delaware, United States Chubb Full time

    Job Title: Multinational Claims Billing AnalystThe Chubb Global Services (CGS) group is responsible for delivering exceptional client services to Chubb's multinational business across a diverse product line. The CGS Finance group oversees global money movement, billing, and collections of reinsurance and deductibles, reporting, and overall multinational...


  • Wilmington, North Carolina, United States InsideHigherEd Full time

    Job Title: Research Programmer/Analyst IIAt The Dartmouth Institute for Health Policy & Clinical Practice, we are seeking a highly skilled Research Programmer/Analyst II to join our team. This role will support research programming and analytic activities for principal investigators and their project teams using administrative claims datasets and other...


  • Wilmington, North Carolina, United States Tandym Group Full time

    Medical Economics SpecialistA leading healthcare organization in Maryland is seeking a Medical Economics Specialist to join their team in a remote capacity. As a key member of the Healthcare Economics team, you will play a crucial role in providing executive leadership with actionable intelligence related to the financial, clinical, and analytical...


  • Wilmington, North Carolina, United States InsideHigherEd Full time

    Job SummaryWe are seeking a highly skilled Research Programmer/Analyst II to join our team at The Dartmouth Institute for Health Policy & Clinical Practice. The successful candidate will be responsible for supporting research programming and analytic activities using administrative claims datasets and other supporting data.Key ResponsibilitiesIdentify and...


  • Wilmington, North Carolina, United States Elevance Health Full time

    Job Title: Business Analyst IIThis role is part of Elevance Health's Business Support team, responsible for reviewing recovery requests from various departments and conducting provider outreach to determine if claims have been overpaid.Key Responsibilities:Review and analyze requests for recoveries from different departments.Conduct provider outreach to...


  • Wilmington, Delaware, United States Gainwell Technologies Full time

    About the RoleWe are seeking a skilled Senior Healthcare Data Analyst to join our team at Gainwell Technologies. As a key member of our team, you will play a crucial role in harnessing the power of technology to improve the health and well-being of our clients' members.Key ResponsibilitiesReview, analyze, and evaluate data/systems business requirements for...


  • Wilmington, North Carolina, United States Johns Hopkins Medicine Full time

    Job Title: Application Systems Analyst IIJoin Johns Hopkins Health Plans, a leader in provider-sponsored health plans, as an Application Systems Analyst II. In this role, you will be a key member of our team, responsible for analyzing and resolving system issues, developing and managing application code, and advising on potential application modifications...


  • Wilmington, North Carolina, United States InsideHigherEd Full time

    Job SummaryWe are seeking a highly skilled Research Programmer/Analyst II to join our team at The Dartmouth Institute for Health Policy & Clinical Practice. As a key member of our research team, you will be responsible for supporting research programming and analytic activities for principal investigators and their project teams.Key ResponsibilitiesIdentify...


  • Wilmington, Delaware, United States State of North Carolina Full time

    Job SummaryThis is a challenging opportunity to join the State of North Carolina as an Insurance Consumer Analyst I. As a key member of the Consumer Services Division, you will be responsible for providing exceptional customer service to NC consumers who call the Consumer Service Division for assistance with their insurance products.Key...


  • Wilmington, North Carolina, United States Johns Hopkins Medicine Full time

    Job SummaryAs a Senior Applications Systems Analyst at Johns Hopkins Health Plans, you will be responsible for leading the development and maintenance of our mission-critical applications and systems. This is a customer-facing role that requires strong communication and analytical skills, as well as the ability to work independently with minimal...


  • Wilmington, North Carolina, United States InsideHigherEd Full time

    Job SummaryWe are seeking a highly skilled Research Programmer/Analyst II to join our team at The Dartmouth Institute for Health Policy and Clinical Practice. The successful candidate will have a strong background in programming and analytics, with experience working with large datasets and statistical software.Key ResponsibilitiesUnder the direction of the...


  • Wilmington, United States Wilmington Health Full time

    About Wilmington Health Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a...


  • Wilmington, United States Corporation Service Company Full time

    Job Description Want to be part of something bigger? We do too. Associate Brand Protection Analyst - Mandarin Fluency Wilmington, DE or Gaithersburg, MD Monday-Friday, 800am - 5:00pm Hybrid As an Associate Brand Protection Analyst, you will be working with existing members of the Enforcement team to assist with the takedown of fraudulent websites, Social...