Performance Integrity Analyst I - ClaimsRemote within WA, OR, ID and UTOnsite 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-remoteWork 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-remoteThe starting base pay for the Performance Integrity Analyst is $20.00 - $28.00 an hour, depending on experience and candidates geographic location. The annual incentive payment target for this position is 5%.At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we do not hire candidates at or near the top of the pay range. Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

Provider Contract Management Specialist

Cambia Health, Salem

Provider Contract Management SpecialistRemote opportunity for residents of OR, WA, ID and UTPrimary Job PurposeThe Provider Contract Management Specialist (PCMS) is responsible for support to ensure accurate development and execution of healthcare provider contracts, support of mass mailings, contract template creation, configuration and maintenance, reporting, and maintenance of the contract database. This position conducts regulatory filings and responds to objections and supports information resourcing for internal and external audits. The PCMS performs research to resolve issues for the Provider Contract Executives, Provider Business Operations, and Provider Enrollment. Provides training to Provider Contract Executives (PCE) on contract management system use and process requirements and training for staff of other departments accessing contract information in the contract database (e.g. Care Management, Audit teams).The Provider Contract Management Specialist Senior (PCMSS) is more experienced and highly proficient in the use of the contract management system/database and related processes and has expert mastery of operational guidelines and standards. The PCMSS serves as a super-user and subject matter expert (SME). The position compiles contract change requests and facilitates process to determine implementation strategy for contract system updates and operational procedures. This position is responsible for contract management system configuration and maintenance related to contract documents. As a super-user and SME, this role mentors PCMS staff and conducts strategic trainings on using and/or accessing information in the contract management system for peers and cross-functional teams. PCMSS also performs system queries and reporting to identify performance, operational accuracy, potential contract development errors, and ensures ongoing maintenance is performed. PCMSS role collaborates and consults with Provider Operations and other stakeholders to define business requirements, rules and standards to be used for data governance and process improvement. PCMSS is responsible to develop and keep current policies, desk procedures, business processes, and business rules/standards.General Functions and OutcomesProvides support for internal and external audit, pulling reports or contracts as requested/needed or coaching others on self-sufficient access to needed information.Supports all Plans' mass mailings.Processes all Plans' Single Case Agreements.Triages and investigates claims/audit inquiries.Develops, maintains, and consults on contract policies, procedures, and desk references for the department.Prepares provider contract documents and templates, including technical "coding" and strategic system configuration in the contract management system and completes maintenance.Contracts are built with "technical coding" to drive ability for alternate choices for contract language and for enhanced reporting capabilities, automation, and data governance. Accuracy and attention to detail in sub-coding and configuration is required to drive correct "language and rates" in contractual documents to avoid contractual issues and payment errors.Peer review of documents, system configuration, and contract submissions to OIC is a critical function of this role to promote accuracy and reduce contract administrative and regulatory risks.Conducts system testing of documents and templates, including technical "coding" and system configuration prior to changes being promoted to the system's Production environment. Tests applications and system functionality.Ability to enforce business requirements and standards with PCEs.Works cross-functionally with Network Management staff to draft, coordinate, implement and revise new and renewing provider contracts in a timely manner. Tracks signed contracts to ensure government guidelines are followed. Answers or facilitates resolution of provider contract inquiries as needed.Works with the legal department, regulatory compliance teams, and Network Management contracting staff to file documents, as applicable, with the Insurance Commissioner/Department of Insurance for each state where the Health Plan contracts with providers.Maintains the relationship with the policy and compliance analyst at the Office of Insurance Commission (OIC).Implements contracting policies and procedures for the department.May research, collect, and analyze competitive information for use in contracting and assist with gathering information and responding to RFPs.Assists with coordination, communication, and interaction with stakeholders on the operations of contract language configuration, contracting system operational standards, , and reimbursement/language configuration for data governance. Assists in answering related questions for internal staff.Implements contracts in the contract management system and coordinates implementation of provider contracts/reimbursement with the Provider Operations, Provider Pricing, and Provider Enrollment staff, including annual fee updates.Provides training and assistance with the contract management system. Instructs others on system use and is the central point of contact for the department in the creation and maintenance of contract documents and templates in the contract management system. Participates in identifying, troubleshooting, and resolving problems.Develops training material and conducts Virtual training sessions.Responsible for the integrity and accuracy of the provider contract database, including ongoing audit of provider information. Effectively maintains contract repository for all contracts. Communicates with all Network Management staff and other divisions as updates are available.Minimum RequirementsProficient computer skills including use of Microsoft Office products or equivalent software and the ability to learn corporate software programs.Action-orientated approach with ability to effectively organize, prioritize, and meet deadlines.Familiarity with report preparation, including ability to organize and review statistical data and write relevant communications.Knowledge of the contract development process desired.Proficiency in grammar, punctuation, and Microsoft Word formatting.Demonstrated teamwork and collaboration with the peers, leadership, and cross-functional teams.Familiarity with the Regence health care provider community, contracting protocol and reimbursement methodologies desired.Excellent oral and written communication skills to effectively interface and communicate with a broad array of internal and external contacts, including state regulatory bodies.Ability to produce accurate work and focus on details.Proficient in identification of all contract types and payment methodologies and know-how to load into system, to develop contract documents and templates, and to maximize operational usage of the contract management system, including system reporting.Proficient in the use of contract filing software and applications in order to manage regulatory compliance needs related to contract document, template, and provider contract/network filings. Filings must be submitted accurately according to state regulatory guidelines and requirements. Normally to be proficient in the competencies listed above:The Provider Contract Management Specialist would have a/an Bachelor's Degree in healthcare, business or related field and 3 years' experience in the healthcare industry with a minimum of one year project-related experience, or equivalent combination of education and experience.The expected hiring range for a Provider Contract Management Specialist is $26.80 - $30.00/ hour depending on location, skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%. The current full salary range for this role is $26.80 - $43.70. #LI-remoteBase pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.