Assistant Director Risk Adjustment Operations

Assistant Director Risk Adjustment Operations

Hybrid role (3 days/week in office) at our Portland, Medford, Fargo, Burlington, Spokane, Vancouver, Renton, Boise, Lewiston or Salt Lake City offices. Candidates must reside within commutable distance of that location.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Risk Adjustment professionals is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Assistant Director Risk Adjustment Operations is responsible for the management and oversight of the Risk Adjustment function supporting Health Plan Government Programs and applicable Commercial Lines of Business. Specific areas of responsibility include leading teams and vendors in:
Quality Assurance and Compliance, Coding, Process and Analytics, and Campaign and Service Provider Management.

– 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 AD Risk Adjustment Operations would have a bachelor's degree in business administration, health administration, finance or related field and 8-10 years of experience in healthcare insurance, Medicare or related programs, management consulting, or equivalent combination of education and experience.

FTEs Supervised

• 6 - 20

Skills and Attributes:

• Demonstrated 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 have an executive presence.

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

• Creates operational plans and leads teams to deliver high-value processes, analytics, data, tools and reporting to effectively achieve identified business objectives across Risk Adjustment.
• Provides oversight and delivery of Risk Adjustment quality and compliance. Develops and manages 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.
• Leads activities, relationships and issue resolution with third-party service providers.
• Regularly communicates organizational objectives and team goals. Monitors results and metrics to ensure deliverables are met and compliant with department and regulatory standards. Collaborates with other leaders and across departments to resolve issues.
• Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, firing, coaching, counseling, and retention. Develops managers and supervisors and participates in talent management activities.
• Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources and oversees project plans.
• In conjunction with division leadership, establishes long term goals for the department and adapts 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.

Oregon, Washington, Utah, and Idaho:
The expected hiring range is $ – $, the full salary range is $ – $. and the bonus target is 15%.

North Dakota:
The expected hiring range is $ - $, the full salary range is $ - $ and the bonus target is 15%.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge…