Policy & Implementation Analyst

Policy & Implementation Analyst (Healthcare) Hybrid within Oregon, 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 dedicated Policy & Implementation team is living our mission to make health care easier and lives better. As a member of the Policy & Implementation team, 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. – all in service of making our members’ health journeys easier. If you're a motivated and detail-oriented clinician looking to make a difference in payment integrity, apply for this exciting opportunity today! What You Bring to Cambia: Preferred Key Experience: 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. Qualifications: Bachelor’s degree in Business Administration or a related field 3 years of experience in a healthcare related environment utilizing analytical skills or an equivalent combination of education and experience. Skills and Attributes (Not limited to): 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. What You Will Do at Cambia (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. The expected target hiring range for this position is $64,000 – $81,000/year 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 $64,000 - $106,000/year. 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 (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. 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 employer dedicated to 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. Everyone is a health care consumer deserving of a simpler, more personalized experience. Cambia 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 BlueCross and BlueShield licensed health plans 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. Interested in driving accessibility, affordability and quality health care for real people? Apply to any of our open jobs or join the Twitter conversation @Cambia. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

Salary : $64,000 - $81,000