Clearinghouse Claims Analyst

2 weeks 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.



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