Policy & Implementation Analyst or Sr. DOE

Policy and Implementation Analyst or Sr. DOE

Hybrid 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 dedicated team of Policy and Implementation Analyst are living our mission to make health care easier and lives better. As a member of the Payment Integrity team, our 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 – all in service of making our members’ health journeys easier.

What if your analytical skills could directly impact thousands of people's health care journeys? Ever wondered what it's like to shape health care policy while building a career with purpose? Then this role may be the perfect fit. 

What You Bring to Cambia: 

Qualifications: 

• Bachelor's degree in Business Administration or a related field

• Minimum 3 years of experience in a healthcare related environment utilizing analytical skills or an equivalent combination of education and experience

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

Skills and Attributes: 

• 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.

• Demonstrated knowledge of the following: CMS reimbursement and medical policies; Medicare products; Procedural and diagnostic coding; and the national Resource Based Relative Value Schedule.

• Ability to prepare and present in depth written technical assessment of medical reimbursement issues relating to claims processing and clinical editing.

• Knowledge of reporting tools, i.e, SQL (Oracle, SQL Server, etc.), or Business Intelligence Tools (SSRS, SAS, Crystal Reports, Business Objectives, etc.) preferred.

• 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.

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:  

• Facilitates development, understanding and documentation of business requirements related to policy implementation, clinical editing, and reimbursement policy development including issue identification, research, approval, implementation, documentation and education

• Performs analysis and creates design and implementation plans to support new and revised medical and reimbursement policies, while maintaining online documentation for accurate and uniform administration

• Creates configuration instructions for clinical edits and preauthorization flags to support policy and ensure accurate implementation in multiple claims editing systems, then tracks, coordinates and oversees policy and related clinical edit and coding issues through the implementation process

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