Policy & Implementation Analyst

Overview

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, you will use medical coding knowledge and experience to evaluate, recommend and implement clinical editing solutions to ensure 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 are a motivated and detail-oriented clinician looking to make a difference in payment integrity, apply for this 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 a 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 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

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 :

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.

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