Hybrid Risk Management Lead – Data, Compliance

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

Benefits offered by this job

Hybrid work schedule

Remote work options

Relocation support

Job summary

Cambia Health Solutions, Inc. in Salt Lake City leads the Risk Management Business Team, overseeing data submission for Enrollment, Medical and Pharmacy Claims within CMS Risk Adjustment programs.

The role requires building a high-performing team and driving accurate data processing across multiple departments. We seek a leader with a strong background in risk adjustment, analytics and project delivery who can guide process improvements, develop underwriting rules and mentor staff while

Qualifications

• Bachelor’s degree in Business, Data Analysis or related field.
• 10 years’ experience with data analysis or related field.
• Strong analytical, problem solving and communication skills.
• Knowledge of risk adjustment systems and processes.
• Experience leading large, complex initiatives.
• Familiar with AI tools to enhance productivity and decision-making.

Responsibilities

• Corroborates with IT, compliance, legal, revenue management, claims, enrollment, product teams and other departments to maximize and maintain submission measurements.
• Oversees RADV audits, submits data in a timely manner and prepares executive reports.
• Develops medical underwriting rules for the Risk Management 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 resolutions to ensure the data submission system is functioning accurately.
• Responsible for staff development, performance conversations, performance coaching and retention activities.
• Regularly communicates departmental and organizational goals and objectives to staff.
• Develops and maintains departmental policies and procedures and assures adherence to departmental standards and practices.
• Oversees the data submission system and ensures it is functioning accurately.

Skills

Analytical skills

CMS / risk adjustment

Project management

Team leadership

Communication skills

Medical terminology

Education

Bachelor’s degree in Business or related field

Job description

Cambia Health Solutions, Inc. in Salt Lake City leads the Risk Management Business Team, overseeing data submission for Enrollment, Medical and Pharmacy Claims within CMS Risk Adjustment programs.

The role requires building a high-performing team and driving accurate data processing across multiple departments. We seek a leader with a strong background in risk adjustment, analytics and project delivery who can guide process improvements, develop underwriting rules and mentor staff while