Salt Lake City, UT · Remote
$19.20 - $34.90/hr
... physicians, nurses, pharmacists, and billing staff both internally and externally, while ... with auditing and investigations of medication-related claims, cases, and providers to identify ...
Salt Lake City, UT · Remote
$19.20 - $34.90/hr
... physicians, nurses, pharmacists, and billing staff both internally and externally, while ... with auditing and investigations of medication-related claims, cases, and providers to identify ...
$17.91 - $20.13
6% of jobs
$20.13 - $22.36
6% of jobs
$22.36 - $24.58
3% of jobs
$26.01 is the 25th percentile. Wages below this are outliers.
$24.58 - $26.80
15% of jobs
$26.80 - $29.03
17% of jobs
The median wage is $29.33 / hr.
$29.03 - $31.25
23% of jobs
$32.05 is the 75th percentile. Wages above this are outliers.
$31.25 - $33.48
15% of jobs
$33.48 - $35.70
8% of jobs
$35.70 - $37.92
0% of jobs
$37.92 - $40.15
0% of jobs
$40.15 - $42.37
7% of jobs
$17
$29
$42
| Aspect | Remote Rn Auditor | Remote Rn Reviewer |
|---|---|---|
| Certifications | RN license, auditing certifications (e.g., CHAP, RAC) | RN license, clinical review certifications |
| Work Environment | Healthcare organizations, insurance companies, auditing firms | Healthcare providers, insurance companies, utilization review |
| Primary Responsibilities | Auditing medical records for compliance, coding accuracy, and billing | Reviewing medical records for appropriateness and medical necessity |
Remote Rn Auditors focus on compliance and coding accuracy through audits, while Remote Rn Reviewers primarily assess medical necessity and appropriateness of care. Both roles require RN licensure and related certifications, often working within healthcare or insurance settings. The key difference lies in their core functions: auditing versus clinical review, though both contribute to quality and compliance in healthcare reimbursement.
As a remote RN auditor, your job is to review claims and audit financial statements to ensure validity and accuracy. In this role, you may examine documentation from the patient or clinic, evaluate the effectiveness of care, or ensure that claims comply with government regulations. RN auditors often provide advice for cutting costs and contact both healthcare providers and clients to negotiate specific claims or resolve billing issues. Remote RN auditors often work with daily or weekly batches of work as assigned, but in rare cases, you may be asked to prioritize auditing certain material when time is of the essence.
$19.20 - $34.90/hr
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 9 days ago
8.4
Based on 32 frontline employees who took The Breakroom Quiz
101st of 281 rated insurance
Pharmacy Services Technician
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 Pharmacy Services Technician, are living our mission to make health care easier and lives better. As a member of the Pharmacy Operations team, our Pharmacy Services Technician is a corporate-wide technical support resource for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. This function assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related operations and other operational processes which require knowledge and experience with pharmaceuticals, all in service of creating a person-focused health care experience.
Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
High school diploma or related certificate required
Three years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting, or equivalent combination of education and experience
Pharmacy Technician certificate may be substituted for two years of experience
Skills and Attributes:
Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS, and HIPAA regulations, along with knowledge of pharmaceutical products including orals, injectables, infusion products, and chemotherapy
Knowledge of general office practices and procedures with demonstrated knowledge of grammar and techniques of business practice
Ability to interact effectively with a variety of health care professionals including physicians, nurses, pharmacists, and billing staff both internally and externally, while demonstrating maturity, tact, diplomacy, and persuasiveness
Demonstrated ability to perform pharmaceutical dosing calculations and operate a variety of standard business machines including calculators and faxes
Ability to type 30 words per minute (60 wpm preferred) with basic computer program skills including Word, Excel, and other standard applications
Ability to organize, plan, and prioritize daily workflow and projects within time constraints; experience with health insurance and/or prescription benefits preferred
Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia:
Perform all duties as described unless clinical judgment is required, in which case seek assistance from appropriate medical personnel who will be available for support during normal business hours
Respond to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, government programs personnel, and customer service regarding formulary drug coverage, appeal and reconsideration claim status
Complete daily formulary operational processes including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals
Prepare reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation including medical chart notes, reports, and medication profiles; communicate information and determinations to providers and members orally and through written documentation as necessary
Obtain and organize drug utilization data including patient-specific and population-based data in a manner that facilitates clinical review and decisions by Clinical Pharmacist Consultants, including sorting drugs into appropriate therapeutic and generic categories
Assist with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of resources, substance abuse, and erroneous and fraudulent billing practices; investigate and organize workflow for claims referred to Pharmacy Services for review and allowable determination including miscellaneous J codes, providers on review, and reconsiderations
Support wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement; contribute to and support the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward quality improvement efforts
#LI - Remote
The expected hiring range for a Pharmacy Services Technician is $20.50 - $30.80 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 5%. The current full hourly range for this role is $19.20 - $34.90 an hour.
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
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Sourced by ZipRecruiter
Health care and social assistance
1,001 - 5,000 Employees
Portland, OR, US
1996
