Claims Analyst

The Health Plan of West Virginia Inc; East Side (WV); On-site; USD 38,000 - 48,000; Full time

Job summary

The Health Plan of West Virginia Inc is seeking a Claims Analyst to perform initial review and processing of medical claims (HCFA 1500 and UB 04) in Charleston, WV. You will ensure adherence to production and quality standards and follow established policies.

Requirements include a high school diploma, familiarity with medical terminology, CPT/ICD-10 coding, strong computer and typing skills, and prior claims processing experience. Billing or physician office experience is preferred.

Qualifications

• Must have familiarity with medical terminology, CPT and ICD-10 coding.
• Proficient computer and typing skills required.
• Prior claims processing experience.
• Billing or physician office experience preferred.

Responsibilities

• Performs initial review of claims edits and routes reviews per established time parameters.
• Reviews claims flags in sequence and completes reviews according to criteria/payment guidelines.
• Reports patterns of incorrect billing to manager or claims coordinator.
• Advises management on unclear items or gaps in criteria/payment guidelines.
• Maintains a quality rating of 98%.
• Processes 15–20 claims per hour.
• Participates in trainings as requested.

Skills

Medical terminology

CPT/ICD-10 coding

Computer skills

Typing

Claims processing

Billing experience

Education

High school diploma or equivalent

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Claims Analyst

Full Time Clerical Charleston, WV, US

2 days ago Requisition ID: 1618

Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies and procedures.

Required:

• High school diploma or equivalent.
• Ability to follow written directions and work independently.
• Familiarity with medical terminology, CPT and ICD-10 coding is required.
• Computer and typing experience is required.
• Previous claims processing.
• Experience in billing or physician office experience is preferred.

Responsibilities:

• Performs initial review of all claim edits as directed. Completes or routes all reviews in accordance with time parameters established by The Health Plan.
• Reviews each claim flag in sequence, totally completing one at a time in accordance with established criteria/payment guidelines.
• Reports patterns of incorrect billing and utilization to manager or claims coordinator.
• Advises management of items that are unclear or that are not addressed in the established criteria/payment guidelines.
• Maintain a quality rating of 98%.
• Processes 15-20 claims per hour.
• Consistently displays a positive attitude and acceptable attendance.
• Participate in external and/or internal trainings as requested.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.