Policy & Implementation Analyst or Sr. DOE

Policy And Implementation Analyst Or Sr. Doe Hybrid 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 dedicated team of policy and implementation analysts are living our mission to make health care easier and lives better. As a member of the payment integrity team, our policy and implementation analyst 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. What You Bring To Cambia: Qualifications: Bachelor's degree in business administration or a related field Minimum 3 years of experience in a healthcare related environment utilizing analytical skills or an equivalent combination of education and experience Current licensure or professional certification relevant to the work (RN or coding certification) is preferred Skills and Attributes: Ability to communicate effectively, verbally and in writing. 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. General computer skills (including use of Microsoft Office, Outlook and internet search). Familiarity with health care documentation systems. Proven ability to perform and manage analytical tasks/projects with the ability to work independently. Demonstrated knowledge of the following: CMS reimbursement and medical policies; Medicare products; Procedural and diagnostic coding; and the national resource based relative value schedule. Ability to prepare and present in depth written technical assessment of medical reimbursement issues relating to claims processing and clinical editing. Knowledge of reporting tools, i.e, SQL (Oracle, SQL Server, etc.), or business intelligence tools (SSRS, SAS, Crystal Reports, Business Objectives, etc.) preferred. 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. Responds to customer inquiries regarding system functionality, modification and status of issue resolution. Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired What You Will Do At Cambia: Facilitates development, understanding and documentation of business requirements related to policy implementation, clinical editing, and reimbursement policy development including issue identification, research, approval, implementation, documentation and education Performs analysis and creates design and implementation plans to support new and revised medical and reimbursement policies, while maintaining online documentation for accurate and uniform administration Creates configuration instructions for clinical edits and preauthorization flags to support policy and ensure accurate implementation in multiple claims editing systems, then tracks, coordinates and oversees policy and related clinical edit and coding issues through the implementation process Proactively identifies and reports medical cost management opportunities, process or system issues and presents findings and recommendations to stakeholders through queries, reports and data analysis that transforms information into practical insights for decision-making Coordinates implementation of new and revised online reference materials, technical documentation and system updates while communicating policy and edit decisions to internal and external customers in a clear and concise manner Collaborates with medical directors to ensure clinically appropriate policies and edits, and partners with other departments to coordinate system implementations, process changes, and investigate claims adjudication and member or provider inquiries Designs and develops comprehensive testing plans that ensure all key areas are tested sufficiently for successful production results The expected hiring range for a policy and implementation analyst is $69,700 - $94,300 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $65,000 - $107,000 . The expected hiring range for a policy and implementation analyst sr is $76,500 - $103,500 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $72,000 - $117,000 . 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 View email address on click.appcast.io. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. #J-18808-Ljbffr Cambia Health Solutions