Claims Analyst

The Health Plan of West Virginia Inc • Charleston, WV

7h

About The Position

Under the direction of the Manager of Claims, the Claims Analyst performs initial reviews of claims, including HCFA 1500 and UB 04 claims. The reviewer is expected to meet or exceed production and quality standards and follow documented policies and procedures. The position operates from 8:00 a.m. to 5:00 p.m. and is listed as 40 hours.

Requirements

• High school diploma or equivalent.
• Ability to follow written directions and work independently.
• Familiarity with medical terminology, CPT, and ICD-10 coding.
• Computer and typing experience.

Nice To Haves

• Previous claims processing experience.
• Experience in billing or a physician’s office.

Responsibilities

• Perform initial review of claim edits as directed and complete or route reviews within The Health Plan’s established time parameters.
• Review each claim flag in sequence, completing one at a time according to established criteria and payment guidelines.
• Report patterns of incorrect billing and utilization to the manager or claims coordinator.
• Advise management of items that are unclear or not addressed in established criteria or payment guidelines.
• Maintain a quality rating of 98%.
• Process 15–20 claims per hour.
• Consistently display a positive attitude and maintain acceptable attendance.
• Participate in external and/or internal trainings as requested.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED