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Assistant Director of Risk Adjustment

Cambia Health Solutions, Inc

This is a Contract position in Lexington, KY posted November 22, 2021.

The position can be located in the four Cambia states
– OR, WA, ID or UT At Cambia, our members need us more than ever, and to continue serving them, we need to be vaccinated.

Following federal mandate, all Cambia Health Solutions employees, including 100% remote workers, need to be fully vaccinated for COVID-19 by 1/1/22.

The Assistant Director of Risk Adjustment 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.

Minimum Requirements: 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.

Strong analytical and business skills including financial/budget management, complex data analytics and data-based decision making.

Ability to develop and lead teams, including: hiring, goal setting, coaching and development of employees who may be in multiple locations or work remotely.

Normally to be proficient in the competencies listed above The Assistant Director of Risk Adjustment 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.

Job Requirements: Responsibilities: 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.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law.

A background check is required.