Utility Analyst
CivilGrid
Policy and Implementation Analyst
Cambia Health Solutions
full-time
Posted on:
Location: Idaho, Oregon, Utah • 🇺🇸 United States
Visit company websiteSalary
💰 $64,000 - $106,000 per year
Job Level
Mid-LevelSenior
Tech Stack
SaltStack
About the role
- Use medical coding knowledge and experience to evaluate, recommend and implement clinical editing solutions to assure accurate outcomes consistent with medical and reimbursement policy and financial targets.
- Develop and execute implementation plans including system updates, business process changes and timely communication.
- Develop, maintain and publish reimbursement policy and online reference materials and technical documentation.
- Facilitate development, understanding and documentation of business requirements related to policy implementation and clinical editing.
- Perform analysis in the design and implementation plans to support new and revised medical and reimbursement policies.
- Coordinate implementation of new and revised online reference materials and technical documentation.
- Communicate policy and edit decisions to internal and external customers in a clear and concise manner.
- Serve as primary support for coding questions across Cambia and ensure coding decision-making is consistent, clinically appropriate and thoroughly documented.
- Apply coding expertise and judgment to assure medically appropriate and accurate claims adjudication.
Requirements
- Clinical knowledge (Understands clinical reviews).
- Understanding of claims, billing and coding.
- Experience with 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.
- Bachelor’s degree in Business Administration or a related field (or equivalent combination of education and experience).
- 3 years of experience in a healthcare related environment utilizing analytical skills (or equivalent combination of education and experience).
- 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 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.
- Ability to apply coding expertise and judgment to assure medically appropriate and accurate claims adjudication.
- Must be able to work hybrid within Oregon, Idaho or Utah (locations listed include Portland, OR; Salt Lake City, UT; Medford, OR; Coeur d'Alene, ID; Lewiston, ID).
- Background check required.
- For remote work option: wired internet connection (not satellite or cellular) with min upload 5Mb and download 10Mb.
