Supervisor Clinical Appeals

Cambia Health Solutions; Bellevue (WA); Remote; USD 86,000 - 141,000; Full time

Job summary

A leading health solutions company is seeking a Supervisor Clinical Appeals to lead a dedicated team. This role involves overseeing clinical appeal decisions, mentoring nursing professionals, and ensuring compliance with medical policies. Candidates should possess a nursing degree, leadership experience, and a strong understanding of health insurance trends. The position offers a competitive salary and benefits, with work-from-home options available.

Benefits

Health coverage

Retirement plans

Paid time off

Wellness programs

Qualifications

• 4 years of leadership experience.
• 7 years of clinical experience or equivalent education and experience.

Responsibilities

• Manage team operations and ensure compliance.
• Lead staff development and performance reviews.
• Collaborate with physicians and departments to resolve complex cases.

Skills

Effective communication skills

Leadership experience

Problem recognition and resolution skills

Knowledge of health insurance trends and technology

Understanding of appeal procedures and clinical practices

Knowledge of CPT, ICD-9, HCPCS, and MCG guidelines

Education

Bachelor’s degree in nursing or a related field

RN License in ID, OR, UT, or WA

Certified Coder

Job description

Join to apply for the Supervisor Clinical Appeals role at Cambia Health Solutions

Work from home within Oregon, Washington, Idaho or 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 clinical leaders live our mission to make health care easier and lives better. As a member of the initial review team, the Supervisor Clinical Appeals supervises the team and acts as a resource for nursing professionals and support staff. This role oversees team activities to meet business objectives and ensures clinical appeal decisions are accurate, consistent with policies, and supported by medical records. The position may also assist in planning, coordinating, conducting, and reporting on clinical appeals, all aimed at making our members’ health journeys easier.

As a people leader, you are eager to learn and grow, supporting your team and the lives that depend on us. If you thrive on mentoring nursing professionals and analyzing medical policies for consistency, this role may be a good fit.

Qualifications

• Bachelor’s degree in nursing or a related field
• 4 years of leadership experience
• 7 years of clinical experience or equivalent education and experience
• RN License in ID, OR, UT, or WA
• Certified Coder (preferred)

Skills And Attributes

• Ability to prioritize and oversee team work
• Effective communication skills
• Leadership experience, including remote teams
• Problem recognition and resolution skills
• Knowledge of health insurance trends and technology
• Understanding of appeal procedures and clinical practices
• Knowledge of CPT, ICD-9, HCPCS, and MCG guidelines
• Medicare regulations (preferred)
• Familiarity with appeals rules by accrediting bodies and government agencies

What You Will Do

• Manage team operations and ensure compliance
• Lead staff development and performance reviews
• Collaborate with physicians and departments to resolve complex cases
• Develop and maintain process documentation and quality standards
• Stay current on medical practices and industry trends
• Serve as a technical resource and provide educational updates
• Handle special projects and seek continuous improvement

Compensation and Benefits

The hiring range is $91,800 - $124,200, with a bonus target of 15%. The full salary range is $86,000 - $141,000. Benefits include health coverage, retirement plans, paid time off, wellness programs, and more. Work from home options are available with required internet specifications.

About Cambia

Cambia offers a purpose-driven culture, innovative solutions, and a focus on community and employee well-being. We value diversity and inclusion and provide equal employment opportunities.