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Performance Integrity Analyst I

Company: Cambia Health Solutions, Inc.
Location: Tacoma
Posted on: November 22, 2021

Job Description:

Primary Job Purpose Remote within Oregon, Washington, Utah and IdahoFollowing federal mandate, all Cambia Health Solutions employees, including 100% remote workers, need to be fully vaccinated for COVID-19 by 1/1/22.The Performance Integrity Analyst I 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.General Functions and Outcomes

  • 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. Work Environment
      • Work overtime and on weekends due to fluctuating workload.
      • Sitting and keying for extended periods of time.

Keywords: Cambia Health Solutions, Inc., Tacoma , Performance Integrity Analyst I, Professions , Tacoma, Washington

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