Hybrid Risk Adjustment Team Lead | Data & Compliance Mgmt

Cambia Health Solutions; Salt Lake City (UT); Hybrid; USD 111,000 - 151,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Generous paid time off

Market-leading 401(k) with company匹配

Bonus opportunities

Job summary

Cambia Health Solutions is seeking a Manager for the Risk Adjustment Business Team to lead data submission and analytics for CMS Risk Adjustment programs. The role emphasizes accuracy, process improvement and cross-functional collaboration across IT, compliance and revenue teams.

The position is hybrid, involving three days in the office and travel as needed. The candidate should bring a business/data background and a track record of leading large initiatives within risk adjustment domains.

Qualifications

• Bachelor's degree in Business, Data Analysis or related field.
• 10 years’ experience in data analysis, process modeling or equivalent combo of education and experience.
• Strong analytical and problem solving skills; ability to translate complex ideas for diverse audiences.
• Experience with risk adjustment systems and processes; project management experience.

Responsibilities

• Corroborates with IT, compliance, legal, revenue management, claims, enrollment, product teams to maximize submission measurements.
• Helps oversee RADV audits and prepares executive reports.
• Develops medical underwriting rules reflecting rating strategy and revenue targets.
• Directs projects and delivers performance criteria and objectives.
• Ensures day-to-day operations are supported and issues are resolved.
• Develops, implements and monitors audit processes for Edge Server usage.
• Oversees staff development, coaching and retention activities.
• Communicates department goals to staff and maintains policies to ensure alignment.

Skills

Analytical skills

Communication

Project management

Risk adjustment knowledge

AI tools experience

Education

Bachelor's degree in Business or Data Analysis

Tools

Risk management systems

Job description

Cambia Health Solutions is seeking a Manager for the Risk Adjustment Business Team to lead data submission and analytics for CMS Risk Adjustment programs. The role emphasizes accuracy, process improvement and cross-functional collaboration across IT, compliance and revenue teams.

The position is hybrid, involving three days in the office and travel as needed. The candidate should bring a business/data background and a track record of leading large initiatives within risk adjustment domains.