Medical Records Analyst I

Medical Review Support Analyst I

Work from home within Washington, Idaho, Oregon, and Utah. Preference will be given to current employees and candidates who reside in Idaho and Utah.

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

Who We Are Looking For:

Every day, Cambia’s dedicated team of Medical Review Support Analysts is living our mission to make health care easier and lives better. As a member of the Quality Management team, our Medical Review Support Analysts triage selected claims against clinical review and audit criteria; request and obtain provider records via letters or EMR; receive, research, and process incoming records; input processing instructions into Facets; update required fields and notes in the department database; and communicate with claims staff and Network Management on claim status and needed records – all in service of creating an economically sustainable health care system.

Do you have a keen eye for detail and a talent for organizing and tracking information accurately? Do you enjoy researching, problem-solving, and following clinical criteria to reach the right outcome? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

- High school diploma or GED
- 3 years of experience in a healthcare field (medical office, customer service, or billing); or
- Related formal education and at least 1 year of experience; or
- An equivalent combination of education and experience

Skills and Attributes:

- Experience with healthcare systems and documentation (medical records, billing, and claims); familiarity with the Facets system preferred
- Proficiency with medical terminology; knowledge of medical anatomy and coding preferred
- Knowledge of Blue Card, ITS processes, FEP Direct, and Salesforce preferred
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
- Math aptitude and analytical ability
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
- Effective communication and writing skills
- Ability to investigate and research issues related to clinical programs and medical records, and to take initiative to solve problems
- Ability to work independently, prioritize work, meet deadlines, and achieve operational standards

What You Will Do at Cambia:

- Performs triage on all selected claims to determine if they meet specific review criteria, and interprets claim history and pre-authorization determinations as needed
- Accurately requests and obtains medical records based on the audit
- Receives, researches, and processes incoming records via fax, mail, email, and secure upload
- Inputs claim processing instructions into Facets, completes and monitors required database fields and notes, and communicates with designated claims staff on the status of claims under review
- Sends detailed notification letters to providers and communicates directly with Network Management regarding missing or needed records
- Meets production requirements and quality standards while following strict guidelines to ensure accuracy, timeliness, quality, and compliance with federal, state, BCBSA, and accreditation regulations
- Contributes to department efficiency by remaining flexible and cross-trained on other functions

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

- Oregon, Washington, Utah, and Idaho: The expected hiring range is $25.55 - $31.20 an hour, the full salary range is $21.60 - $38.40 an hour, and the bonus target is 5%.
- The bonus target for this position is 5%.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

- Work alongside diverse teams building cutting-edge solutions to transform health care.
- Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
- Grow your career with a company committed to helping you succeed.
- Give back to your community by participating in Cambia-supported outreach programs.
- Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

- 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.

Learn more about our benefits .

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.

We are an Equal Opportunity employer dedicated to 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 .