Policy & Implementation Analyst

* Clinical knowledge (Understands clinical reviews)
* Understanding of claims, billing and coding
* Facets/claims systems in appeals, SIU
* Claims processing, claims configuration roles
* Understanding of Medical and reimbursement policies
* CPC Certified or willing to get CPC Certified as condition to 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 and/or participate in discussions and develop conclusions with internal and external medical professionals and other experts.
* Demonstrated knowledge of the following: 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 decision-making related to coding is consistent, clinically appropriate and thoroughly documented.
* Applies coding expertise and judgment to assure medically appropriate and accurate claims adjudication.
* Facilitates development, understanding and documentation of business requirements related to policy implementation and clinical editing.
* Performs analysis in the design and implementation plans to support new and revised medical and reimbursement policies.
* Responsible for maintaining online documentation for accurate and uniform administration of medical and reimbursement policy.
* Coordinates the implementation of new and revised online reference materials and technical documentation.
* Communicates policy and edit decisions to internal and external customers in a clear and concise manner.
* 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..###
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