Senior Medical Policy Implementation Specialist

Cambia Health Solutions, Inc.; Arkansas; Hybrid; USD 80,000 - 130,000; Full time

Benefits offered by this job

Health coverage

HSA

Paid time off

Retirement plan

Parental leave

Wellness programs

Employee assistance

Commute benefits

Job summary

Cambia Health Solutions, Inc. seeks a Medical Policy Implementation Analyst Senior to translate complex clinical policies into accessible guidance for members and providers.

The role spans multiple lines of business and requires collaboration with Medical Directors and internal staff to draft, interpret and publish policy criteria. Hybrid role with in-office three days weekly across listed offices; candidates from commutable areas or willing to relocate are preferred.

Qualifications

• Bachelor's degree in health science or related field and 5 years of experience in working with medical policies and 3 years of direct clinical experience or equivalent combination of education and experience.
• Certified Professional Coder (CPC), if no CPC currently, employee must attain CPC within 6 months of hire.
• Register Nurse (RN) license (must have a current unrestricted RN license)

Responsibilities

• Draft, interpret and apply medical policies; present policy criteria to Medical Directors for approval.
• Track utilization and appeals to inform policy changes.
• Apply CPT, HCPCS, and ICD coding to policy criteria with impact awareness.
• Publish and maintain a web library of clinical criteria accessible to internal and external customers.
• Collaborate with system users and databases to ensure consistent policy application.
• Develop and maintain department procedures.
• Manage project tasks, set objectives and timelines with minimal supervision.
• Interpret and summarize scientific literature and guidelines to inform policy drafting.
• Use guideline summaries to update policy criteria.
• Advise stakeholders regarding policy questions and outcomes.

Skills

Policy development

CPT/ICD/HCPCS coding

Utilization review

CMS guidelines

Data analysis

Project management

Communication

AI tools experience

Education

Bachelor's degree in health science or related field

Registered Nurse (RN) license

Certified Professional Coder (CPC)

Tools

Microsoft Office

EHR systems

Job description

Cambia Health Solutions, Inc. seeks a Medical Policy Implementation Analyst Senior to translate complex clinical policies into accessible guidance for members and providers.

The role spans multiple lines of business and requires collaboration with Medical Directors and internal staff to draft, interpret and publish policy criteria. Hybrid role with in-office three days weekly across listed offices; candidates from commutable areas or willing to relocate are preferred.