Integrity Clinician

Position: Payment Integrity Clinician I
** PAYMENT INTEGRITY RN (HEALTHCARE)
** Work from home (telecommute) within
** Oregon, Washington, Idaho or Utah
**** Build a career with purpose. Join our*
* ** to create a person-focused and economically sustainable health care system.
***** 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!**
* ** What You Bring to Cambia:
*** 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.
* Competency to apply clinical expertise to ensure compliance with medical policies and/or 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 working software programs (i.e. Microsoft Word, Excel, and PowerPoint); learn new processes and systems 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.
* Applies nursing expertise to ensure compliance with medical and reimbursement policies and/or guidelines and accepted standards of care.
* Ensures that medical records and other documentation requirements follow federal regulations, company policies and industry standards.
* Serves members and providers by performing reviews of claims along with corresponding medical records (when required) to ensure appropriate payment of claims.
* Consults with physician advisors to ensure clinically appropriate determinations.
* Collaborates with other departments to resolve member or provider claims adjudication issues.
* Responds in writing or telephonically to internal and external customers in a professional and diplomatic manner while protecting confidentiality of sensitive documents and issues.
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
* Award-winning wellness programs that reward you for participation.
* Employee Assistance Fund for those in need.
* Commute and parking benefits.

Everyone is a health care consumer deserving of a simpler, more personalized experience.  is transforming the health care system to revolve around people. For over 100 years we’ve designed people-first health solutions rooted in the nation’s first health plan, a loggers’ wage pool established in the Pacific Northwest. Today that pioneering spirit aligns our family of over 20 companies, including 4 not-for-profit  serving over 3 million Americans.

Cambia blends data science with a compassionate human perspective to anticipate people’s needs, and empower them to make smarter health care choices..###
* Information about how Cambia Health Solutions collects, uses, and discloses information is available in our .
* #J-18808-Ljbffr