Medical Records Analyst

Work from home within Washington, Idaho, Oregon, and Utah. Preference will be given to current employees and candidates who reside in Idaho and 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 team of Medical Review Support Analysts is living our mission to make health care easier and lives better. As a member of the Quality Management team, our Medical Review Support Analysts triage selected claims against clinical review and audit criteria; request and obtain provider records via letters or EMR; receive, research, and process incoming records; input processing instructions into Facets;

update required fields and notes in the department database; and communicate with claims staff and Network Management on claim status and needed records – all in service of creating an economically sustainable health care system.

Do you have a keen eye for detail and a talent for organizing and tracking information accurately? Do you enjoy researching, problem-solving, and following clinical criteria to reach the right outcome? Then this role may be the perfect fit.

High school diploma or GED 3 years of experience in a healthcare field (medical office, customer service, or billing); or Related formal education and at least 1 year of experience; or An equivalent combination of education and experience

Experience with healthcare systems and documentation (medical records, billing, and claims); familiarity with the Facets system preferred Proficiency with medical terminology; knowledge of medical anatomy and coding preferred Knowledge of Blue Card, ITS processes, FEP Direct, and Salesforce preferred Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired Math aptitude and analytical ability Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired Effective communication and writing skills Ability to investigate and research issues related to clinical programs and medical records, and to take initiative to solve problems Ability to work independently, prioritize work, meet deadlines, and achieve operational standards

Performs triage on all selected claims to determine if they meet specific review criteria, and interprets claim history and pre-authorization determinations as needed Accurately requests and obtains medical records based on the audit Receives, researches, and processes incoming records via fax, mail, email, and secure upload Inputs claim processing instructions into Facets, completes and monitors required database fields and notes, and communicates with designated claims staff on the status of claims under review Sends detailed notification letters to providers and communicates directly with Network Management regarding missing or needed records Meets production requirements and quality standards while following strict guidelines to ensure accuracy, timeliness, quality, and compliance with federal, state, BCBSA, and accreditation regulations Contributes to department efficiency by remaining flexible and cross-trained on other functions

The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history. Oregon, Washington, Utah, and Idaho:
The expected hiring range is $25.55 - $31.20 an hour, the full salary range is $21.60 - $38.40 an hour, and the bonus target is 5%. The bonus target for this position is…