Integrity RN

Overview

Join to apply for the Payment Integrity Clinician I role at Cambia Health Solutions
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Work from home (telecommute) within Oregon, Washington, Idaho or Utah.

Build a career with purpose and help create a person-focused and economically sustainable health care system.

Every day, Cambia’s Clinical Audit Team is living our mission to make health care easier and lives better. Payment Integrity Clinician I conducts post service review of claims in prepayment, post payment or audit capacity to ensure appropriate clinical review, reimbursement of claims and accuracy of coding. Applies resources, including but not limited to, internal medical and reimbursement policies and correct coding guidelines based on national standards to support claim review and determination.

– all in service of making our members’ health journeys easier.

If you're a motivated and experienced RN with Claims or Reimbursement experience looking to make a difference in the healthcare industry, apply for this exciting opportunity today!

• Experience with Government Programs such as FEP and Medicare
• Reimbursement Policy
• Claims
• Clinical Auditor or reviewer

• Associates or Bachelor's Degree in Healthcare, or related fields
• 3 years of experience in a clinical setting, health insurance, coding/claims review, case management
• Equivalent combination of education and experience

• Knowledge of medical and surgical procedures and other healthcare practices
• Ability to apply clinical expertise to ensure compliance with medical and reimbursement policies
• Ability to read and interpret medical records and patient data and communicate effectively with clinical and non-clinical staff
• Excellent computer skills and proficiency with Microsoft Word, Excel, and PowerPoint; learn new processes quickly
• Strong verbal, written and interpersonal communication and customer service skills
• Ability to work in rapidly changing environment
• Strong research, analytical, math and problem-solving skills

• Apply nursing expertise to ensure compliance with medical and reimbursement policies and/or guidelines and accepted standards of care
• Ensure medical records and documentation follow federal regulations, company policies and industry standards
• Review claims along with corresponding medical records to ensure appropriate payment of claims
• Consult with physician advisors to ensure clinically appropriate determinations
• Collaborate with other departments to resolve member or provider claims adjudication issues
• Respond in writing or by phone to internal and external customers professionally while protecting confidentiality of sensitive documents

The expected hiring range for the Payment Integrity RN is $85k–$95k, depending on skills, experience, education, and training; relevant licensure/certifications; performance history; and work location. The bonus target for this position is 10%. The full salary range for this position is $78k Low/ $89k Midpoint/ $116k High.

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our colleagues are committed to helping members live healthy lives and making a difference in our communities.

• Work alongside diverse teams building cutting-edge solutions to transform health care
• Earn a competitive salary and generous benefits
• Grow your career with a company dedicated to your success
• Participate in Cambia-supported outreach programs
• Connect with colleagues through employee resource groups

Our compensation package includes competitive base pay, a market-leading 401(k) with company match, bonus opportunities and more.

• 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 and potential discretionary contribution
• Up to 12 weeks of paid parental time off
• We…