[Hiring] Performance Integrity Analyst I @Cambia Health Solutions

Role Description

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Every day, Cambia's dedicated Performance Integrity Analysts I are living our mission to make health care easier and lives better. As a member of the Quality Training and Documentation team, our Performance Integrity Analysts:

• Audit high dollar claims according to established provider contracts, pricing methodologies, core systems, procedures, and audit guidelines.
• Submit findings to accountable business owners for review and acceptance.
• Validate that required corrective actions have been completed.
• Provide feedback and recommendations for quality improvement to management.

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

Qualifications

• Two years of experience as a claim processor, or an equivalent combination of education and job-related experience, depending on current business needs.
• 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, and applicable systems including Facets, eVIPS, and Radar.
• 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.

Requirements

• Audit claims for accuracy according to audit policies, procedures, and guidelines.
• Encourage team and individual contributions toward the company's quality initiatives and 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.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.