Clinical Payment Specialist

6 days ago


Bellingham, Washington, United States Cambia Health Solutions Full time
Work with Purpose

Cambia Health Solutions seeks a Clinical Payment Specialist to join our team. This role is an exciting opportunity for a motivated and detail-oriented clinician to make a difference in payment integrity.

About the Role

This position conducts post-service reviews of claims to ensure appropriate clinical review, reimbursement of claims, and accuracy of coding. The ideal candidate will have at least 5 years of clinical experience as an RN at an acute inpatient hospital, exceptional critical thinking skills, and the ability to work independently as well as part of a team.

Key Responsibilities
  • Apply nursing expertise to ensure compliance with medical and reimbursement policies and/or guidelines and accepted standards of care.
  • Ensure that medical records and other documentation requirements follow federal regulations, company policies, and industry standards.
  • Serve members and providers by performing reviews of claims along with corresponding medical records (when required) to ensure appropriate payment of claims.
Requirements
  • Unrestricted licensure or certification within either OR, WA, ID, or UT in a health or human services discipline that allows the professional to conduct an assessment independently.
  • At least 5 years of clinical experience as an RN at an acute inpatient hospital.
  • Exceptional critical thinking skills.
  • Ability to work independently as well as part of a team.
What We Offer

Cambia Health Solutions offers a competitive salary range of $95,000 - $110,000 per year, depending on experience. Our comprehensive benefits package includes health insurance, retirement savings plan, paid time off, and more.



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