Claims Analyst - MHT

Under the direction of the Manager of Claims, the reviewer performs initial review of claims, including HCFA 1500 and UB 04 claims. Reviewer must meet or exceed production and quality standards and follow documented policies and procedures.

Required:

• High dipolma 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.

Desired:

• Previous claims processing.
• Experience in billing or physician office experience is preferred.

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.