Supervisor Clinical Appeals

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

Job summary

Join a leading health solutions company as a Supervisor Clinical Appeals, overseeing a team to ensure accurate clinical appeal decisions. This role involves mentoring nursing professionals, managing operations, and collaborating with various departments to enhance member health journeys. Ideal candidates will have a nursing degree, leadership experience, and a strong understanding of health insurance policies.

Qualifications

• 4 years of leadership experience.
• 7 years of clinical experience or equivalent.
• RN License required.

Responsibilities

• Manage team operations and performance monitoring.
• Lead staff development through coaching and training.
• Collaborate with departments to resolve complex cases.

Skills

Leadership

Communication

Team Development

Problem Solving

Health Insurance Knowledge

Education

Bachelor’s degree in nursing

Certified Coder

Job description

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Who We Are Looking For

Every day, Cambia’s dedicated team of clinical leaders are living our mission to make health care easier and lives better. As a member of the initial review team, our Supervisor Clinical Appeals supervises the team and acts as a resource for nursing professionals and support staff. This role oversees and coordinates team activities to achieve business objectives and ensures that clinical appeal decisions are accurate and consistent with medical policies, reimbursement policies, provider contracts, member benefits and supported by the medical record. The position may also assist in planning, coordinating, conducting and reporting on clinical appeals – all in service of making our members’ health journeys easier.

As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Do you thrive on mentoring and supporting nursing professionals? Are you skilled at analyzing medical policies and ensuring consistency in decision-making? Then this role may be the perfect fit.

Qualifications

What You Bring to Cambia:

• Bachelor’s degree in nursing or a related field
• 4 years of leadership experience
• 7 years of clinical experience or an equivalent combination of education and experience
• RN License within one of the four operating states (ID, OR, UT, WA)
• Certified Coder certified with the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) preferred

Skills And Attributes

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
• Effective verbal and written communication skills for diverse audiences.
• Ability to develop and lead a team, including remote teams.
• Experience in resolving complex issues and recognizing problems.
• Knowledge of health insurance industry trends and technology.
• Familiarity with appeal procedures and clinical practices.
• Knowledge of CPT, ICD-9, HCPCS coding, and MCG guidelines.
• Medicare regulations knowledge is preferred.
• Understanding of rules applied to appeals by accrediting bodies, state and federal agencies, and employers.

What You Will Do At Cambia

• Manage team operations, including work prioritization, goal setting, and performance monitoring, ensuring compliance with policies.
• Lead staff development through coaching, training, and performance reviews.
• Collaborate with physician advisors and other departments to resolve complex cases.
• Develop and maintain process documentation, implement improvements, and ensure quality standards.
• Stay current on medical practices and industry trends to maintain clinical competency.
• Provide educational updates and serve as a technical resource.
• Manage special projects and seek continuous improvement opportunities.

Supervise 8-15 FTEs. The salary range is $91,800 - $124,200, with a bonus target of 15%. The full salary range is $86,000 - $141,000.