Payment Integrity RN

6 days ago


Vancouver, Washington, United States Cambia Health Solutions Full time
Job Title: Payment Integrity RN

Cambia Health Solutions is seeking a highly skilled Payment Integrity RN to join our Clinical Audit team. As a Payment Integrity RN, you will play a critical role in ensuring the accuracy and integrity of medical claims and reimbursement processes.

Key Responsibilities:
  • Conduct post-service reviews of claims to ensure compliance with medical and reimbursement policies
  • Apply clinical expertise to ensure compliance with medical policies and/or reimbursement policies
  • Collaborate with physician advisors to ensure clinically appropriate determinations
  • Respond to internal and external customers in a professional and diplomatic manner while protecting confidentiality of sensitive documents and issues
Requirements:
  • At least 5 years of clinical experience as an RN
  • Exceptional critical thinking skills
  • Ability to work independently and as part of a team
  • Strong verbal, written, and interpersonal communication skills
  • Ability to work in a rapidly changing environment
What We Offer:
  • A dynamic and supportive work environment
  • Opportunities for professional growth and development
  • A competitive salary and benefits package

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