Medical Records Analyst I

This is a fully remote position, open to applicants in Idaho, +3 more states.

📋 Description

• Evaluate selected claims based on clinical review and audit criteria.

• Request and secure provider medical records through letters or electronic medical records (EMR).

• Receive, investigate, and process incoming records via fax, mail, email, and secure upload methods.

• Enter claim processing instructions into the Facets system.

• Update necessary fields and notes within the departmental database.

• Interpret claim histories and pre-authorization determinations as needed.

• Communicate with claims personnel and Network Management regarding claim status and any required or missing records.

• Dispatch detailed notification letters to providers.

• Adhere to production requirements and quality standards while complying with federal, state, BCBSA, and accreditation regulations.

• Maintain flexibility and receive cross-training on other functions to enhance departmental efficiency.

⛳️ Requirements

• High school diploma or GED is required.

• A minimum of 3 years of experience in a healthcare setting (medical office, customer service, or billing); or related formal education coupled with at least 1 year of experience; or an equivalent combination of education and experience.

• Familiarity with healthcare systems and documentation, including medical records, billing, and claims is essential.

• Experience with the Facets system is preferred.

• Proficient in medical terminology.

• Knowledge of medical anatomy and coding is preferred.

• Understanding of Blue Card, ITS processes, FEP Direct, and Salesforce is preferred.

• Experience with AI tools and technologies to improve productivity and decision-making in professional environments is highly desired.

• Strong mathematical aptitude and analytical skills.

• Excellent communication and writing abilities.

• Capability to investigate and analyze issues related to clinical programs and medical records, taking the initiative to resolve problems.

• Ability to work independently, prioritize tasks, meet deadlines, and achieve operational standards.

• Must be able to work from home in Washington, Idaho, Oregon, or Utah.

• A wired internet connection (not satellite or cellular) with a minimum upload speed of 5Mb and download speed of 10Mb is required.

• Access to a personal mobile device for Multi-Factor Authentication is necessary.

• A background check is required.

🏝️ Benefits

• 5% bonus target.

• Competitive salary.

• Market-leading 401(k) with a substantial company match.

• Opportunities for bonuses.

• Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.

• Annual employer contribution to a health savings account.

• Generous paid time off.

• 10 company-paid holidays.

• Leading retirement plan with company match on employee 401(k) contributions.

• Potential discretionary retirement contributions based on company performance, with no vesting period.

• Up to 12 weeks of paid parental leave after 12 months of continuous service.

• Award-winning wellness programs that incentivize participation.

• Access to an Employee Assistance Fund.

• Benefits for commuting and parking.

• Options for working from home.

• Employee resource groups.

• Community outreach programs supported by Cambia.