Clearinghouse Claims Analyst

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Job description

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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