Payment Integrity RN

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.

Work from home (telecommute) 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 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 you're a motivated and experienced RN with Payment Audit experience looking to make a difference in the healthcare industry, apply for this exciting opportunity today!

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.