Payment Integrity Nurse

🕒 July 23

🥔 Idaho, North Dakota, +3 more states – Remote

🥔 Idaho – Remote 🌾 North Dakota – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $72k - $117k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 26%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Cambia Health Solutions

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare • Healthcare Insurance • Non-profit

Cambia Health Solutions is a nonprofit, mission-driven healthcare company based in Portland, Oregon, that operates consumer-focused health care and health insurance businesses and invests in health innovation. It serves as the parent organization for the Regence family of health plans and runs initiatives and subsidiaries focused on improving care delivery, providing insurance products, and developing digital health tools and services.

📋 Description

• Conduct post-service review of claims in prepayment, post-payment, or audit capacity • Ensure appropriate clinical review, claim reimbursement, and coding accuracy • Apply internal medical and reimbursement policies and correct coding guidelines based on national standards • Ensure medical records and documentation comply with federal regulations, company policies, and industry standards • Review claims and corresponding medical records to ensure appropriate payment • Consult physician advisors on clinically appropriate determinations • Collaborate with departments to resolve member and provider claims adjudication issues • Respond in writing or by telephone to internal and external customers while protecting confidential information • Plan, organize, and prioritize assignments according to performance standards, corporate goals, guidelines, and timelines • Maintain clinical competency through relevant conferences, workshops, and seminars at least annually • Maintain working knowledge of clinical coding applications • Complete courses and continuing education to maintain licensure and certifications

🎯 Requirements

• Associates or Bachelor's Degree in Healthcare • Minimum 3 years of experience in a clinical setting, health insurance, coding/claims review, case management, or equivalent combination of education and experience • Unrestricted licensure or certification in Oregon, Washington, Idaho, or Utah in a health or human services discipline allowing independent assessment within scope of practice • Minimum 3 years of direct clinical care experience • Bachelor's degree or higher in a health or human services-related field, or current unrestricted Registered Nurse (RN) license • Psychiatric RN or Master's degree in Behavioral Health preferred for behavioral health • Certified Professional Coder (CPC) certification preferred • Knowledge of medical and surgical procedures and healthcare practices • Ability to apply clinical expertise to medical and reimbursement policies • Ability to read and interpret medical records and patient data • Proficiency with Microsoft Word, Excel, and PowerPoint • Strong verbal, written, interpersonal communication, and customer service skills • Strong research, analytical, math, and problem-solving skills • Ability to work independently, multitask, and prioritize with minimal supervision • Experience with AI tools and technologies highly desired • Ability to maintain required licensure and applicable certifications • Background check required • Wired internet connection required for work-from-home option; minimum 5Mb upload and 10Mb download speeds; satellite or cellular internet is not permitted • Personal mobile device required for Multi-Factor Authentication

🏖️ Benefits

• Competitive base pay • Bonus opportunities; 10% bonus target for Oregon, Washington, Utah, and Idaho • Medical, dental and vision coverage for employees and eligible family members, including mental health benefits • Annual employer contribution to a health savings account • Generous paid time off varying by role and tenure • 10 company-paid holidays • 401(k) company match • Potential discretionary 401(k) contribution based on company performance, with no vesting period • Up to 12 weeks of paid parental time off, subject to eligibility • Wellness programs that reward participation • Employee Assistance Fund • Commute and parking benefits • Work-from-home options • Employee resource groups • Professional growth and development opportunities • Community outreach opportunities