Payment Integrity RN
Payment Integrity RN
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1 Vacancy
Job Description
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 personfocused and economically sustainable health care system.
Who We Are Looking For:
Every day Cambias Payment Integrity 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 youre a motivated and experienced RN with Payment Audit experience looking to make a difference in the healthcare industry apply for this exciting opportunity today!
What You Bring to Cambia:
Qualifications and Certifications:
Associates or Bachelors Degree in Healthcare
3 years of experience in a clinical setting health insurance coding/claims review case management or 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 nonclinical 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 problemsolving skills.
Ability to work independently; detailoriented.
Must be able to multitask and set priorities with minimal supervision.
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.
The expected hiring range for The Payment Integrity RN is $85k$90k 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 purposedriven awardwinning 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 personfocused health care. Whether were 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 cuttingedge 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 Cambiasupported 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 marketleading 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 companypaid holidays.
- Marketleading 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).
- Awardwinning 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 tobaccofree 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 . Information about how Cambia Health Solutions collects uses and discloses information is available in our .
Employment Type
Full-Time
