Mgr Risk Management Business Team

Manager – Risk Adjustment Business Team 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 Risk Management Business Team Manager is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Management Business Team Manager is responsible for complying with CMS mandates to submit Enrollment, Medical Claim and Pharmacy Claim data for Reinsurance and Risk Adjustment programs.  Leads a team dedicated to extracting required information from the source systems into a staging area, performing validation checks based on CMS Edge Server Business Rules, and submitting correct data to the Edge Server via a translation process.

– 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:

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…