Clinical Auditor RN

2 weeks ago


Bellingham, Washington, United States Cambia Health Solutions Full time

Job Summary

Cambia Health Solutions is seeking a skilled Clinical Auditor RN to join our team. As a member of our Clinical Audit team, you will conduct post-service reviews of claims to ensure accurate reimbursement and compliance with medical policies and guidelines.

Key Responsibilities

  • Apply nursing expertise to ensure compliance with medical and reimbursement policies and/or guidelines.
  • Review medical records and other documentation to ensure accuracy and completeness.
  • Collaborate with physician advisors to ensure clinically appropriate determinations.
  • Respond to internal and external customers in a professional and diplomatic manner.

Requirements
  • Unrestricted licensure or certification as a Registered Nurse (RN) in Oregon, Washington, Idaho, or Utah.
  • At least 3 years of direct clinical care experience.
  • Exceptional critical thinking skills and ability to adapt to change.
  • Strong verbal, written, and interpersonal communication skills.

About Cambia Health Solutions
Cambia Health Solutions is a leading healthcare company dedicated to making healthcare easier and lives better. We are committed to creating a person-focused and economically sustainable healthcare system.
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