Assistant Director Payment Integrity Policy & Implementation

Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston offices.

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo and Lewiston offices or who are willing to relocate.

Who We Are Looking For:

Every day, Cambia's dedicated team of Payment Integrity leaders are living our mission to make health care easier and lives better. As a member of the Affordability leadership team, our Assistant Director Integrity Policy & Implementation develops strategy, directs, and oversees reimbursement and coding policy activities and drives operationalization of internal and vendor opportunities. These activities include services pertaining to: Correct coding and reimbursement reviews/methodologies, Policy assessment and development, lead Reimbursement Policy Committee, consultation of system wide implementation of payment policies, establish an ongoing ideation and PI initiative development team, act as a key stakeholder in trend management, direct coding disputes team, and strategies on optimization of payment edits and rules across all internal and vendor supported applications - all in service of creating a person-focused health care experience.

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 want to lead strategic initiatives that directly impact how people experience health care? Are you looking to grow your career at a mission-driven organization that values innovation and ethical leadership? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Masters (or higher) degree in a health-related field required. Masters in public health, business administration, public administration, or other related field desired
• Minimum of seven years of management or professional business experience in a managed health care system, medical group, hospital, or related business in health care delivery industry or an equivalent combination of education and experience

Skills and Attributes:

• Demonstrate strong policy, coding and operational understanding and strategy to ensure seamless execution of new PI policies and initiatives.
• Demonstrated strong knowledge of health care economics and financing; health care industry dynamics; and provider contracting strategies, techniques, and processes
• Demonstrated success in managing professional business relationships in a managed care system, medical group, hospital, or related business in health care delivery industry
• Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability; ability to function effectively as a management team member
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

• Lead strategic planning and execution of reimbursement policy, coding disputes, and Payment Integrity ideation initiatives, including program tracking, financial justification, and prioritization in collaboration with Healthcare and Clinical Services leadership, legal, and healthcare informatics
• Provide vision, direction, and leadership to teams by developing budgets, policies, workflows, and change management plans while monitoring results and metrics to ensure strategic goals, deliverables, and regulatory compliance are achieved
• Oversee the Reimbursement Policy Committee to ensure proposed policies are operational and vetted across all enterprise stakeholders including legal, compliance, benefits, network, claims, operations, and strategic finance
• Direct innovation teams and coding disputes resolution to develop and execute new affordability initiatives across all tools and levers, ensuring quality reviews, timely policy updates, and appropriate payment implementation operations
• Leverage deep knowledge of health plan operations, multi-industry best practices, and emerging trends to provide strategic viewpoints and long-term roadmaps for reimbursement policy and Payment Integrity strategies, including consultation on legislative and regulatory issues
• Maintain effective program governance by driving accountability, ensuring timely completion of deliverables, identifying critical risks and dependencies, escalating issues to executive management, and communicating requirements to relevant work streams and business partners
• Direct data infrastructure systems, enhancements, and upgrades that support policy development and implementation while evaluating business needs for IT infrastructure, developing team KPIs and metrics, and collaborating in the RFP process for new and existing initiatives
• As a member of our strong leadership community, you will provide direction to your team, engage them towards common goals and create a positive experience that helps people flourish.

FTEs Supervised

• 3-6 Direct FTEs and 40-60 Total FTEs

#LI-Hybrid

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

• Oregon, Washington, Utah, and Idaho: The expected hiring range is $121,600 - $164,500, the full salary range is $114,000 - $186,000 and the bonus target is 15%.
• North Dakota: The full salary range is $101,444 - $167,383 and the bonus target is 15%.

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.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.