Appeals Clinician I

Cambia Health Solutions; Burlington (IA); Remote; USD 10,000 - 60,000; Full time

Job summary

Cambia Health Solutions is seeking an Appeals Clinician I to work from home in select states. The role involves utilizing nursing expertise to resolve member and provider appeals, ensuring compliance with health policies. Candidates should have a Bachelor's Degree in Nursing and relevant clinical experience.

Benefits

Competitive pay

Comprehensive benefits

Flexible work options

Purpose-driven culture

Qualifications

• 3 years of clinical, insurance, coding/claims review, or case management experience required.

Responsibilities

• Apply nursing expertise to ensure compliance with policies and guidelines.
• Conduct clinical appeal reviews.
• Consult with physician advisers when needed.
• Educate non-clinical staff on clinical cases.

Skills

Claim review and billing experience

Knowledge of medical procedures and healthcare practices

Ability to interpret medical records and communicate complex topics

Proficiency in Microsoft Office

Coding knowledge

Education

Bachelor's Degree in Nursing

State or territorial licensure or certification in a health or human services discipline

RN license in OR, WA, ID, or UT

Job description

Join to apply for the Appeals Clinician I role at Cambia Health Solutions

Work from home within Oregon, Washington, Idaho or Utah.

About the Role

Every day, Cambia’s dedicated team of Appeals Clinicians live our mission to make health care easier and lives better. As part of the Health Services Organization, you will utilize clinical expertise to resolve member and provider appeals, making health journeys easier for our members.

Qualifications

• Bachelor's Degree in Nursing
• 3 years of clinical, insurance, coding/claims review, or case management experience
• State or territorial licensure or certification in a health or human services discipline, allowing independent assessment
• RN license in OR, WA, ID, or UT

Skills and Attributes

• Claim review and billing experience
• Knowledge of medical procedures and healthcare practices
• Ability to interpret medical records and communicate complex topics
• Proficiency in Microsoft Office and coding knowledge

Responsibilities

• Apply nursing expertise to ensure compliance with policies and guidelines
• Conduct clinical appeal reviews
• Consult with physician advisers when needed
• Educate non-clinical staff on clinical cases

The hiring range is $36.40 - $49.20/hour, with a 10% bonus target. Full salary range: $34.20 - $55.70/hour.

Benefits and Culture

We offer competitive pay, comprehensive benefits, flexible work options, and a purpose-driven culture focused on trust, innovation, and community impact.