Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and 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 “America's Best Hospitals” by U.S. News & World Report, we have an excess of 1,100 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:
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.
One to three years of revenue cycle management experience in a healthcare environment.
One year experience with a clearinghouse preferred.
Post End DateAug 15, 2025EEO Posting StatementChristiana 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.