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    Performance Integrity Analyst I - Portland, United States - Cambia Health Solutions

    Cambia Health Solutions
    Cambia Health Solutions Portland, United States

    4 days ago

    Default job background
    Upper Management / Consulting
    Description

    Performance Integrity Analyst I - Claims

    Remote within WA, OR, ID and UT

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

    • 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
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