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Cambia Health Solutions logo
Cambia Health Solutions

Cambia Health Solutions is a nonprofit organization dedicated to changing healthcare through a “person-focused and economically sustainable system.” As an e

Performance Integrity Analyst I

Location

United States

Posted

26 days ago

Salary

$19 - $27 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Performance Integrity Analyst I

Cambia Health Solutions

Role Description Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia's dedicated Performance Integrity Analysts I are living our mission to make health care easier and lives better. As a member of the Quality Training and Documentation team, our Performance Integrity Analysts: - Audit high dollar claims according to established provider contracts, pricing methodologies, core systems, procedures, and audit guidelines. - Submit findings to accountable business owners for review and acceptance. - Validate that required corrective actions have been completed. - Provide feedback and recommendations for quality improvement to management. Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. Qualifications - Two years of experience as a claim processor, or an equivalent combination of education and job-related experience, depending on current business needs. - Ability to understand and apply mathematical concepts. - Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel, and Outlook. - Knowledge of claims coding, and applicable systems including Facets, eVIPS, and Radar. - Audit experience desirable. - Ability to organize and prioritize work. - Must be detail-oriented and self-motivated. - Must be able to communicate effectively both orally and in writing. Requirements - Audit claims for accuracy according to audit policies, procedures, and guidelines. - Encourage team and individual contributions toward the company's quality initiatives and improvement efforts. - Participate in team efforts to develop or update department standards. - Provide feedback on department's performance in reaching service and performance level goals. - Remain continuously current on changes and/or additions to all other applicable departments' policies, procedures, and guidelines. - Thoroughly investigate problems. - Identify and report inconsistencies or ambiguities in manuals, policies, and guidelines. Benefits - 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.

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