Performance Integrity Analyst I - Claims at Cambia Health in Coeur d'Alene, Idaho

Job Description:

Performance Integrity Analyst I - Claims


Remote within WA, OR, ID and UT

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  Onsite is available to those who reside near one of our office locations within our 4 state region.
  
  
  


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  Facets knowledge is strongly encouraged.
  
  
  

Primary Job Purpose:



The Performance Integrity Analyst will examine and validate Plan and employee performance according to established policies, procedures and mandated audit guidelines. Monitor accuracy and timeliness of claims, membership and customer service to meet performance and service level goals. Provide reports, feedback and recommendations for quality improvement to management.




Responsibilities:

• Audit claims, enrollment, or customer service activities for accuracy and timeliness according to audit policies, procedures and mandated guidelines.
  
  


• Encourage team and individual contributions toward the company's quality initiatives in 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.
  
  


• Compile performance statistics and identify potential trends.
  
  


• Generate reports.
  
  


• Participate in testing implemented system changes.
  
  

Minimum Requirements:

• Four years experience in Claims, Membership or Customer Service, depending on current business need, or equivalent combination of education and job-related experience.
  
  


• 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, BlueCard, membership and customer service processes, applicable systems including pricing and provider contract language.
  
  


• 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.
  
  


• A written test may be administered. #LI-remote
  
  

Work Environment:

• Work overtime and on weekends due to fluctuating workload.
  
  


• Duties performed in a fast-paced office environment.
  
  


• Sitting and keying for extended periods of time.
  
  

#LI-remote



The starting base pay for the Performance Integrity Analyst is $20.00 - $28.00 an hour, depending on experience and candidates geographic location. The annual incentive payment target for this position is 5%.


At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we do not hire candidates at or near the top of the pay 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 Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
  


• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
  


• paid time off varying by role and tenure in addition to 10 company holidays
  
  


• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
  


• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
  


• one-time furniture and equipment allowance for employees working from home
  
  


• up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.
  
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.


If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site. Apply Now