Policy & Implementation Analyst

Policy & Implementation Analyst (Healthcare) – Hybrid within Oregon, Idaho or Utah

Build a career with purpose. Join our cause to create a person‑focused and economically sustainable health care system.

Every day, Cambia’s dedicated Policy & Implementation team is living our mission to make health care easier and lives better. As a member of this team, you will use medical coding knowledge and experience to evaluate, recommend, and implement clinical editing solutions that ensure accurate outcomes aligned with medical and reimbursement policy and financial targets. You will develop and execute implementation plans, including system updates, business process changes, and timely communication, while publishing reimbursement policy to make members’ health journeys easier.

If you are a motivated, detail‑oriented clinician looking to make a difference in payment integrity, this is an exciting opportunity. The role offers a competitive salary and an inclusive, purpose‑driven culture that values innovation and community impact.

• Facilitate development, understanding, and documentation of business requirements related to policy implementation and clinical editing.
• Perform analysis in the design and implementation plans to support new and revised medical and reimbursement policies.
• Maintain online documentation for accurate and uniform administration of medical and reimbursement policy.
• Coordinate the implementation of new and revised online reference materials and technical documentation.
• Communicate policy and edit decisions to internal and external customers clearly and concisely.

• Bachelor’s degree in Business Administration or a related field.
• 3 years of experience in a healthcare related environment utilizing analytical skills, or an equivalent combination of education and experience.

• Clinical knowledge (understanding of clinical reviews).
• Understanding of claims, billing and coding.
• Experience with facets/claims systems in appeals, SIU.
• Claims processing, claims configuration roles.
• Understanding of medical and reimbursement policies.
• Must be CPC Certified or willing to obtain CPC Certification as a condition of the position.

• Understanding of claims processing to evaluate implementation needs.
• Demonstrated analytical ability to identify problems, develop solutions, and implement a chosen course of action.
• Ability to present issues, lead or participate in discussions, and develop conclusions with internal and external medical professionals and other experts.
• Knowledge of CMS reimbursement and medical policies, Medicare products, procedural and diagnostic coding, and the national Resource Based Relative Value Schedule.
• Serves as primary support for CPT/HCPCS procedure and ICD‑9/ICD‑10 diagnosis coding questions across Cambia, ensuring consistent and clinically appropriate decision‑making.
• Applies coding expertise to ensure medically appropriate and accurate claims adjudication.

The expected target hiring range for this position is $64,000 – $81,000 per year, depending on skills, experience, education, and training. A bonus target of 10% is included, and the full salary range is $64,000 – $106,000 per year.

Benefits include:

• Medical, dental and vision coverage for employees and eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off and 10 company‑paid holidays.
• Market‑leading retirement plan with company match on 401(k) contributions and potential discretionary contribution based on company performance.
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service).
• Award‑winning wellness programs and employee assistance funds.
• Commute and parking benefits.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same.

We offer flexible work from home options for most roles. Eligible employees must have a wired internet connection (not satellite or cellular) with a minimum upload speed of 5 Mb and a download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco‑free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

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