Why The Health Plan of West Virginia
FY2024 · Form 990Its mission and biggest programs, as filedImproves community health and well-being through technology-driven services and professional partnerships.
- The Health Plan offers a managed care program for mountain Health trust (mht), West virginia's medicaid program. At december 31, 2024, the Health plan's mht Plan serviced 100,002 members with 42,679 members enrolled from the expansion population, 41,915 members enrolled…$501M spent in FY2024
- The Health Plan offers a medicare advantage program known as secure care and a program for members eligible for both medicare and medicaid known as a medicare dual special needs Plan (dsnp). Secure care enables the medicare eligible population to…$136M spent in FY2024
- The primary exempt purpose of the Health Plan of West virgina, INC. (the Health Plan) is to operate a state certified, federally qualified Health maintenance organization (hmo) which provides comprehensive Health care services on a prepaid basis. The number of…$124.3M spent in FY2024
Before you apply
FY2024 · Form 990Independent: from IRS data, not the orgAbout the role
The org's own posting, as writtenUnder 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 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. 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.
Equal Opportunity
Employer The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law.
The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment. 8:00am - 5:00pm 40
About The Health Plan of West Virginia
From its Form 990- Budget $772.7M
- Staff 643 · founded 1979
- Pays its leaders $241K–$691K (12 reported)
- Open jobs 19 · Jobs at The Health Plan of West Virginia · Full 990 report