Remote RN Appeals Clinician I

Cambia Health; Renton (WA); Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

401(k) with company match

Paid time off

Job summary

Cambia Health is seeking an Appeals Clinician I to support clinical decision-making on member and provider appeals. This role emphasizes nursing expertise, adherence to medical policy, and collaboration with physician advisers while working remotely in Oregon, Washington, Idaho or Utah.

Ideal candidates hold an RN license and have 3+ years in clinical settings or health insurance, with strong skills in claims review, coding, and policy interpretation to resolve complex appeals.

Qualifications

• Bachelor's Degree in Nursing and 3 years of clinical experience, health insurance or claims review preferred.
• Active RN license in OR/WA/ID/UT and the ability to assess independently.
• Experience applying medical policy and coding knowledge during appeals.

Responsibilities

• Applies nursing expertise to ensure written appeal decisions comply with policies.
• Conducts clinical appeal reviews in line with benefits and contracts.
• Consults with physician advisers for clinically appropriate determinations.
• Advises and educates non-clinical appeals staff on clinical cases.

Skills

Clinical assessment

Billing/claims review

Medical policy knowledge

CPT/ICD coding

Communication skills

Reading medical records

Education

Bachelor's in Nursing

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Cambia Health is seeking an Appeals Clinician I to support clinical decision-making on member and provider appeals. This role emphasizes nursing expertise, adherence to medical policy, and collaboration with physician advisers while working remotely in Oregon, Washington, Idaho or Utah.

Ideal candidates hold an RN license and have 3+ years in clinical settings or health insurance, with strong skills in claims review, coding, and policy interpretation to resolve complex appeals.