Payment Integrity RN

Cambia Health Solutions • Tacoma, WA • 48min ago

PAYMENT INTEGRITY RN (HEALTHCARE) Work from home (telecommute) 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: 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! What You Bring to Cambia: Preferred Key Experience:

Experience with Government Programs such as FEP and Medicare

Reimbursement Policy

Claims

Clinical Auditor or reviewer

Qualifications and Certifications:

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

Skills and Attributes (Not limited to):

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.

What You Will Do at Cambia (Not limited to):

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.

The expected hiring range for The Payment Integrity RN $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 current full salary range for this position is $78k Low/ $89k MRP / $116k High 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 To view the full job description,

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