Medical Records Analyst I

Cambia Health Solutions

. Triage selected claims against clinical review and audit criteria .

Posted 9/29/2026full-timeRemote • United StatesJunior💰 $22 - $38 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates proficiency in healthcare systems, medical terminology, and claims processing while effectively communicating with providers and claims staff. Capable of meeting production requirements and quality standards in compliance with federal and state regulations.

Highest-signal resume keywords

Healthcare Systems ExperienceFacets System FamiliarityMedical Terminology ProficiencyClaims Processing SkillsEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingMedical Records ManagementBilling KnowledgeAnalytical AbilityMath Aptitude

Soft Skills

Effective CommunicationProblem-Solving InitiativeIndependent WorkPrioritization Skills

Tools & Technologies

FacetsSalesforceAI Tools and Technologies

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Medical OfficeCustomer ServiceBlue CardITS ProcessesFEP Direct

About the role

Key responsibilities & impact

Triage selected claims against clinical review and audit criteria
Request and obtain provider medical records via letters or EMR
Receive, research, and process incoming records via fax, mail, email, and secure upload
Input claim processing instructions into Facets
Update required fields and notes in the department database
Interpret claim history and pre-authorization determinations as needed
Communicate with claims staff and Network Management regarding claim status and needed or missing records
Send detailed notification letters to providers
Meet production requirements and quality standards while following federal, state, BCBSA, and accreditation regulations
Remain flexible and cross-trained on other functions to support department efficiency

Requirements

What you’ll need

High school diploma or GED
3 years of experience in a healthcare field (medical office, customer service, or billing); or related formal education and at least 1 year of experience; or an equivalent combination of education and experience
Experience with healthcare systems and documentation, including medical records, billing, and claims
Familiarity with the Facets system preferred
Proficiency with medical terminology
Knowledge of medical anatomy and coding preferred
Knowledge of Blue Card, ITS processes, FEP Direct, and Salesforce preferred
Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
Math aptitude and analytical ability
Effective communication and writing skills
Ability to investigate and research issues related to clinical programs and medical records, and take initiative to solve problems
Ability to work independently, prioritize work, meet deadlines, and achieve operational standards
Ability to work from home within Washington, Idaho, Oregon, or Utah
Wired internet connection, not satellite or cellular, with minimum upload speed of 5Mb and download speed of 10 Mb
Access to a personal mobile device for Multi-Factor Authentication
Background check required

Benefits

Comp & perks

5% bonus target
Competitive salary
Market-leading 401(k) with a significant company match
Bonus opportunities
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
Market-leading retirement plan with company match on employee 401(k) contributions
Potential discretionary retirement contribution based on company performance, with no vesting period
Up to 12 weeks of paid parental time off after 12 months of continuous service
Award-winning wellness programs that reward participation
Employee Assistance Fund
Commute and parking benefits
Work from home options
Employee resource groups
Cambia-supported community outreach programs