Manager - Risk Adjustment Business TeamHybrid 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.What You Bring to Cambia: Qualifications: The Manager, Risk Management Business Team would have a Bachelor's degree in Business, Data Analysis or other related field and 10 years' experience with data analysis, process modeling or equivalent combination of education and experience.
Skills and Attributes: - Strong analytical skills including the ability to analyze complex data and situations, learn quickly and synthesize corresponding solutions, options and action plans.
- Ability to understand, translate and communicate complex ideas and situations to a wide variety of audiences.
- Excellent research and problem solving skills including the ability to determine action steps and remediation actions to resolve issues.
- Strong knowledge of risk adjustment systems and processes.
- Demonstrated experience in business areas, working with business requirements, documentation and data systems.
- Strong knowledge of project management processes and practices including experience leading large, complex initiatives.
- Knowledge of medical terminology and procedure coding.
- Ability to communicate effectively verbally and in writing with all levels of staff.
- Ability to develop and lead a team including: hiring, goal setting, motivating, coaching and staff development.
- Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
What You Will Do at Cambia: - Corroborates closely with the IT, compliance, legal, revenue management, claims, enrollment, product teams and other departments to maximize and maintain submission measurements
- Helps oversee RADV audits, submits data in a timely manner and prepares executive reports.
- Develops medical underwriting rules for the Risk Management business system which accurately reflect the rating strategy and drive achievement of company revenue targets.
- Directs business projects and is responsible for the development and delivery of project performance criteria and objectives.
- Ensures day-to-day operations are appropriately supported by the Risk Management business team, identifying issues and recommending solutions.
- Develops and reviews business policies, processes and practices to ensure seamless coordination with the Risk Management business team.
- Develops, implements and monitors audit processes to ensure accurate utilization of the Edge Server system by assigned users. Responsible for training materials and delivery.
- Regularly interacts with the IT team, identifying issues and partnering on resolutions to ensure the data submission system is functioning accurately.
- Responsible for staff development, performance conversations, performance coaching and retention activities. Regularly communicates departmental and organizational goals and objectives to staff.
- Develops and maintains departmental policies and procedures and assures adherence to departmental standards and practices.
- Oversees the data submission system and ensures it is functioning accurately.
Work Environment- Work performed in the office or remote.
- Travel rarely required, locally, or out of State.
Oregon, Washington, Utah, and Idaho: The expected hiring range is $111,400.00 - $150,700.00, the full salary range is $104,000.00 - $171,000.00 and the bonus target is 17%
North Dakota: The full salary range is 101,444 - 167,383 and the bonus target is 15%.
