POLICY & IMPLEMENTATION ANALYST

Work from home within Oregon, Washington, Idaho or Utah

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

Who We Are Looking For :

The Policy and Implementation Analyst uses Medical coding knowledge and experience and evaluates, recommends and implements clinical editing solutions to assure accurate outcomes consistent with medical and reimbursement policy and financial targets.

This role develops and executes implementation plans to include system updates, business process changes and timely communication.

The position develops, maintains and publishes reimbursement policy.

Are you a detail-oriented problem solver with a passion for ensuring accurate outcomes in healthcare? Do you have experience in medical coding and clinical editing?

We're searching for a talented Policy and Implementation Analyst to join our team!

Preferred Key Experience :

• Clinical knowledge (Understands clinical reviews)
• Understanding of claims, billing and coding
• Facets / FEP / Claims systems in appeals, SIU
• Claims processing, claims configuration roles
• Understanding of Medical and reimbursement policies

What You Bring to Cambia :

Qualifications :

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

Required Licenses, Certifications, Registration, Etc.

Current licensure or professional certification relevant to the work (coding certification) is preferred.

Skills and Attributes (Includes but not limited to) :

• Ability to communicate effectively, verbally and in writing.
• 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.
• General computer skills (including use of Microsoft Office, Outlook and internet search).
• Familiarity with health care documentation systems.
• Proven ability to perform and manage analytical tasks / projects with the ability to work independently.

What You Will Do at Cambia (Includes but not limited to) :

• 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.
• Creates configuration instructions for clinical edits and preauthorization flags to support medical and reimbursement policy and ensure accurate implementation in multiple claims editing systems.
• Tracks, coordinates and oversees medical and reimbursement policy and related clinical edit and coding issues through the implementation process.
• The expected target hiring range for this position is $66.7k - $90.2k depending on skills, experience, education, and training;

relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%. The current full salary range for this position is $62.

5k Low Range / 78.5k MRP / $102.5k High Range.

About Cambia

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 caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.

Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can :

• 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.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include :

• 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 (eligible day one of employment if within first 12 months following birth or adoption).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and 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.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.

com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Last updated : 2024-06-08