Cambia Health Hiring for Policy & Implementation Analyst (RN) – R-4121_40483885656_4-4185 at Boise, Idaho Full Time

This job was posted by https://idahoworks.gov : For more information,
please see: https://idahoworks.gov/jobs/2074024 Policy &
Implementation Analyst (RN)

Telecommute Option – Must reside in ID, OR, UT or WA

WHO WE NEED

The 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.

Preferred Key Experience:

• RN / Registered Nurse Highly Preferred
• Clinical knowledge (Understands clinical reviews)
• Understanding of claims, billing and coding
• Understanding of Medical and reimbursement policies
• CPC Certified or willing to get CPC Certified as condition to
  position.

Normally to be proficient in the competencies listed below

Policy and Implementation Analyst would have a Bachelor’s degree in
Business Administration or a related field and 3 years of experience in
a healthcare related environment utilizing analytical skills or an
equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

Current licensure or professional certification relevant to the work (RN
or coding certification) is preferred.

YOUR ROLE:

• 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.
• Collaborates with other departments to coordinate system
  implementations, process changes, investigate claims adjudication
  and member or provider inquiries.
• Collaborates with medical directors to ensure clinically appropriate
  polices and edits.
• Identifies data necessary for project, analyzes and transforms data
  into practical information for communication to stakeholders to
  drive and support decisions.
• Designs and develops testing plans that ensure all key areas are
  tested sufficiently for successful production results.
• Develops reimbursement policies and coordinates reimbursement policy
  development to include identification of issues, policy research and
  development, policy approval, policy implementation and policy
  documentation and education.

WHAT YOU BRING:

• 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.
• D monstrated knowledge of the following: 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 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.

The expected hiring range for this position is $66.7k – $90.2k
depending on skills, experience, education, and training; relevant
licensure / certifications; performance history; and work location. The
bonus target for this position is 10%. The current full salary range for
this role is $62.5k Low Range / $78.5k MRP / $102.5k High Range.

Base pay is just part of the compensation package at Cambia that is
supplemented with an exceptional 401(k) match, bonus opportunity and
other benefits. In keeping with our C