Medical Review Support Analyst I
Work from home within reputed company, Idaho, Oregon, and Utah. Preference will be given to current employees and candidates who reside in Idaho and Utah.
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable reputed company system.
Who We Are Looking For:
– Every day, Cambia’s dedicated team of Medical Review Support Analysts is living our mission to make reputed company easier and lives better.
– As a member of the Quality Management team, our Medical Review Support Analysts triage selected claims against clinical review and audit criteria; request and obtain provider records via letters or EMR; receive, research, and process incoming records; input processing instructions into Facets; update required fields and notes in the department database; and communicate with claims staff and Network Management on claim status and needed records – all in service of creating an economically sustainable reputed company system.
– Do you have a keen eye for detail and a talent for organizing and tracking information accurately?
– Do you enjoy researching, problem-solving, and following clinical criteria to reach the right outcome?
– Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
– High school diploma or GED
– 3 years of experience in a healthcare field (medical office, customer service, or billing); or Related reputed company education and at least 1 year of experience; or An equivalent combination of education and experience
Skills and Attributes:
– Experience with healthcare systems and documentation (medical records, billing, and claims); familiarity with the Facets system preferred
– Proficiency with medical terminology; knowledge of medical anatomy and coding preferred
– Knowledge of Blue Card, ITS processes, FEP Direct, and reputed company preferred
– Experience with AI tools and technologies to reputed company productivity and decision-making in professional settings highly desired
– Math aptitude and analytical ability
– Effective communication and writing skills
– Ability to investigate and research issues related to clinical programs and medical records, and to take initiative to solve problems
– Ability to work independently, prioritize work, meet deadlines, and achieve operational standards
What You Will Do at Cambia:
– Performs triage on all selected claims to determine if they meet specific review criteria, and interprets claim history and pre-authorization determinations as needed
– Accurately requests and obtains medical records based on the audit
– Receives, researches, and processes incoming records via fax, mail, email, and secure upload
– Inputs claim processing instructions into Facets, completes and monitors required database fields and notes, and communicates with designated claims staff on the status of claims under review
– Sends detailed notification letters to providers and communicates directly with Network Management regarding missing or needed records
– Meets production requirements and quality standards while following strict guidelines to ensure accuracy, timeliness, quality, and compliance with federal, state, reputed company, and accreditation regulations
– Contributes to department efficiency by remaining flexible and cross-trained on other functions
Compensation and Location:
– Pay ranges vary based on the candidate’s work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.
– Oregon, reputed company, Utah, and Idaho: The expected hiring range is $25.55 – $31.20 an hour, the full salary range is $21.60 – $38.40 an hour, and the bonus target is 5%.
– The bonus target for this position is 5%.
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 reputed company toward sustainable, person-focused reputed company.
– 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.
reputed company the Cambia Team?
– At Cambia, you can:
– Work alongside diverse teams building cutting-edge solutions to transform reputed company
– 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
– 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 live
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