Medical Claims Analyst: Detail-Driven Reviewer

The Health Plan (THP); Wheeling (WV); On-site; USD 32,000 - 52,000; Full time

Job summary

The Health Plan in Wheeling, WV is seeking a Claims Reviewer to perform initial review of HCFA 1500 and UB 04 claims under the direction of the Manager of Claims. Typical work hours shown as 8:00am - 5:00pm, with production and quality standards to meet.

You will review edits, follow established guidelines, and report any patterns of incorrect billing while maintaining a 98% quality rating and processing 15-20 claims per hour.

Qualifications

• Familiarity with medical terminology, CPT and ICD-10 coding is required.
• Ability to follow written directions and work independently.
• Computer and typing experience is required.

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.

Skills

Medical terminology

Follow written directions

Independent work

Typing

Computer skills

Claims processing

Education

High school diploma or equivalent

Job description

The Health Plan in Wheeling, WV is seeking a Claims Reviewer to perform initial review of HCFA 1500 and UB 04 claims under the direction of the Manager of Claims. Typical work hours shown as 8:00am - 5:00pm, with production and quality standards to meet.

You will review edits, follow established guidelines, and report any patterns of incorrect billing while maintaining a 98% quality rating and processing 15-20 claims per hour.