Clearinghouse Claims Analyst

Do you want to work at one of the Top 100 Hospitals in the nation We are guided by our values ofLoveandExcellenceand are passionate about delivering health not just health care. Come join us at ChristianaCare!

ChristianaCare with Hospitals in Wilmington and Newark DE as well as Elkton MD is one of the largest health care providers in the Mid-Atlantic Region. Named one of Americas Best Hospitals by U.S. News & World Report we have an excess of 1100 beds between our hospitals and are committed to providing the best patient care in the region. We are proud to that Christiana Hospital Wilmington Hospital our Ambulatory Services and HomeHealth have all received ANCC Magnet Recognition.

PRIMARY FUNCTION:

The Claims Analyst is responsible for overseeing and managing the flow of electronic claims and remittances through assigned clearinghouses. This includes daily reconciliation issue resolution system maintenance payer configuration and ongoing support for internal teams. The analyst ensures that claims are billed in compliance with federal state and payer-specific regulations and manages all Electronic Funds Transfer (EFT) Electronic Remittance Advice (ERA) and Electronic Date Interchange (EDI) enrollments to support accurate and timely reimbursement.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Clearinghouse and Claims Management

• Reviews and monitors claim inventory in assigned clearinghouses daily to ensure timely export and submission of claims excluding those with documented hold reasons.

• Identifies and escalates claim outliers to Billing Managers providing data-driven insights and resolution recommendations.

• Proactively investigates new and recurring errors collaborating with Billing Managers to determine necessary workflow changes system configuration updates or ticket submissions to the appropriate clearinghouse or IT support teams.

• Manages clearinghouse tickets and vendor correspondence to ensure timely resolution of technical and submission issues.

• Maintains accurate mapping of payer IDs and payer configurations in the clearinghouse system.

EFT ERA EDI Enrollment and Management

• Coordinates and completes EFT ERA and EDI enrollment applications for all payers as needed ensuring all required documentation is accurate and submitted promptly.

• Tracks status of EFT ERA and EDI submissions and follows up to resolve delays or denials in coordination with payer representatives.

• Maintains a centralized log or tracking tool for all EFT ERA and EDI activity and enrollment statuses.

• Provides updates and training to billing staff on EFT ERA and EDI processes and changes in payer requirements.

• Routinely monitors paper claim generation and paper checks to identify opportunities to convert to electronic formats for more expeditious processing.

System Support and Reporting

• Performs daily reconciliation between the host billing system and clearinghouses to confirm successful claim transmissions and payment remittance posting.

• Serves as a clearinghouse system administrator managing user access including assigning logins resetting passwords and addressing access-related issues.

• Assists with testing and implementation of clearinghouse or billing system upgrades and new functionality.

• Runs trend reports and conducts detailed analysis of claim submission data payer rejections or processing delays; presents findings to Billing Managers and recommends corrective actions.

• Provides training and orientation for new users and periodic refresher sessions for current staff on clearinghouse functionality and best practices.

• Notifies users of scheduled system maintenance payer updates or process changes impacting claim transmission or remittance activity.

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Bachelors 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 bachelors degree.

• One to three years of revenue cycle management experience in a healthcare environment.

• One year experience with a clearinghouse preferred.

Christiana Care Health System is an equal opportunity employer firmly committed to prohibiting discrimination whose staff is reflective of its community and considers qualified applicants for open positions without regard to race color sex religion national origin sexual orientation genetic information gender identity or expression age veteran status disability pregnancy citizenship status or any other characteristic protected under applicable federal state or local law.