POLICY & IMPLEMENTATION ANALYST
Work from home within Oregon, Washington, Idaho or Utah
Build a career with purpose. Join our to create a person-focused and economically sustainable health care system.
Who We Are Looking For:The Policy and Implementation Analyst 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.
Are you a detail-oriented problem solver with a passion for ensuring accurate outcomes in healthcare? Do you have experience in medical coding and clinical editing? We're searching for a talented Policy and Implementation Analyst to join our team!
Preferred Key Experience:
Clinical knowledge (Understands clinical reviews)
Understanding of claims , billing and coding
Facets/FEP/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
an equivalent combination of education and experience.
Required Licenses, Certifications, Registration, Etc.
Current licensure or professional certification relevant to the work (coding certification) is preferred.
Skills and Attributes (Includes but not limited to):
Ability to communicate effectively, verbally and in writing.
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.
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.
What You Will Do at Cambia (Includes but 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.
Creates configuration instructions for clinical edits and preauthorization flags to support medical and reimbursement policy and ensure accurate implementation in multiple claims editing systems.
Tracks, coordinates and oversees medical and reimbursement policy and related clinical edit and coding issues through the implementation process.
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