Assistant Director Risk Adjustment Operations

About the role

Cambia is seeking an Assistant Director Risk Adjustment Operations to join our Risk Adjustment team. This role is hybrid (3 days/week in office) and candidates must reside within commutable distance of one of our Portland, Medford, Fargo, Burlington, Spokane, Vancouver, Renton, Boise, Lewiston or Salt Lake City offices.

Responsibilities

• Leading teams and vendors in Quality Assurance and Compliance
• Managing and overseeing Coding
• Overseeing Process and Analytics
• Managing Campaign and Service Provider Management

Qualifications

• Bachelor's degree in business administration, health administration, finance or related field
• 8-10 years of experience in healthcare insurance, Medicare or related programs, management consulting, or equivalent combination of education and experience

Skills and Attributes

• Experience managing and leading a variety of healthcare (or related) operations functions and associated teams
• Knowledge of Medicare Advantage and/or Affordable Care Act rules and regulations, preferably with experience related to Risk Adjustment policies and best practices
• Ability to communicate effectively, verbally and in writing, across the organization from individual contributors to senior executives
• Ability to analyze complex situations and synthesize corresponding solutions, options, and action plans to staff
• Ability to coordinate cross-functionally to drive solutions and resolve issues in a timely and effective manner
• Demonstrated experience working with third-party service providers, building collaborative working relationships and teams, leading a matrix structure, and having an executive presence
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do

• Create operational plans and lead teams to deliver high-value processes, analytics, data, tools and reporting to effectively achieve identified business objectives across Risk Adjustment
• Provide oversight and delivery of Risk Adjustment quality and compliance
• Develop and manage related audit processes and QA organization
• Accountable for delivering internal HCC coding production and quality
• Accountable for the delivery and oversight of Risk Adjustment Campaign results and quality, service provider Service Level Agreements (SLAs), and operational reporting
• Lead activities, relationships and issue resolution with third-party service providers
• Regularly communicate organizational objectives and team goals
• Maintain monitoring results and metrics to ensure deliverables are met and compliant with department and regulatory standards
• Collaborate with other leaders and across departments to resolve issues
• Handle all management level responsibilities for staff, including performance reviews, employee development, hiring, firing, coaching, counseling, and retention
• Develop managers and supervisors and participate in talent management activities
• Manage financial targets and department budget, authorize expenditures, monitor workforce allocation and resources and oversee project plans
• In conjunction with division leadership, establish long-term goals for the department and adapt operational plans as changes occur

Work Environment

• Work primarily performed in office environment
• Travel may be required, locally, out of state, or internationally
• May be required to work outside normal hours

About Cambia

Cambia is a purpose-driven organization committed to making health care easier and lives better. We are dedicated to creating a person-focused and economically sustainable health care system. Our team is passionate about serving others and learning new things, and we thrive as part of a collaborative, caring team.

Why Join the Cambia Team?

• Work alongside diverse teams building cutting-edge solutions to transform health care
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives
• Grow your career with a company committed to helping you succeed
• Give back to your community by participating in Cambia-supported outreach programs
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits
• Annuity employer contribution to a health savings account
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays
• Award-winning wellness programs that reward you for participation
• Employee Assistance Fund for those in need
• Commute and parking benefits

Contact Information

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.