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The Health Plan (THP) · 10 hours ago

Claims Analyst

Charleston, WV

Full-time

Onsite

New Grad, Entry Level

The Health Plan (THP) is seeking a Claims Analyst who will perform initial reviews of claims under the direction of the Manager of Claims. The role involves ensuring claims meet production and quality standards while adhering to established policies and procedures.

Health CareInsuranceNon ProfitWellness

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

Qualification

CPT codingICD-10 codingClaims processingMedical terminologyComputer experienceTyping experienceFollow directionsWork independently

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

Preferred

Previous claims processing

Experience in billing or physician office experience is preferred

Company

The Health Plan (THP)

The Health Plan is a clinically-driven, technology-enhanced, and customer-focused health maintenance organization that manages and improves the health and well-being of its members.

Founded in 1979