Claims Analyst 1

Claims Analyst 1
Wheeling, WV Charleston, WV
Full-Time
Operations, Medicaid and Medicare
Manager of Department

The reviewer performs an initial review of claims, including HCFA 1500 and UB 92 claims. 

The reviewer must meet or exceed production and quality standards and follow documented policies and procedures. 

This is a level 1 of 3 levels for this position.
Level 1:
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 the Benefit Services Unit Manager.
Advises supervisor of items that are unclear or that are not addressed in the established criteria/payment guidelines.

  • Ability to follow written directions and work independently;
  • Familiarity with Medical terminology, CPT and ICD-10 coding;
  • Computer and typing experience;
  • Experience in billing or physician office experience is preferred.

Employment Documents

EEO

Or, if you are interested in a fast-paced career with us, please send resume with salary requirements to:

HR Department 
1110 Main Street
Wheeling, WV 26003-2704
hr@healthplan.org