Healthcare Claims Quality 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

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.