Risk Adjustment Programs Manager

Cambia Health; Burlington (WA); Hybrid; USD 111,000 - 151,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Annual HSA contribution

Generous PTO and holidays

Company 401(k) with match

Parental leave

Wellness programs

Employee Assistance Fund

Job summary

Cambia Health seeks a Manager, Risk Management Business Team to lead data submissions for CMS risk adjustment programs. Hybrid role with in-office days in multiple listed locations and a focus on ensuring accurate data flows from source systems to Edge Server translation.

The role requires a Bachelor's degree and 10+ years in data analysis or process modeling, plus strong leadership and analytical skills. Expect collaboration across IT, compliance, and revenue teams and a drive to improve

Qualifications

• Bachelor's degree in Business, Data Analysis or related field.
• 10 years' experience with data analysis, process modeling or equivalent combination.

Responsibilities

• Corroborates with IT, compliance, legal, revenue management, and other teams to maximize submission measurements.
• Oversees RADV audits, submits data timely and prepares executive reports.
• Develops medical underwriting rules for the Risk Management system.
• Directs projects and defines performance criteria and objectives.
• Ensures day-to-day operations are supported by the team and resolves issues.
• Develops and maintains policies and procedures; staff training and development.

Skills

Analytical skills

Data analysis

Project management

Risk adjustment knowledge

Communication

Team leadership

Education

Bachelor's degree in Business, Data Analysis or related field

Tools

Edge Server

AI tools

Job description

Cambia Health seeks a Manager, Risk Management Business Team to lead data submissions for CMS risk adjustment programs. Hybrid role with in-office days in multiple listed locations and a focus on ensuring accurate data flows from source systems to Edge Server translation.

The role requires a Bachelor's degree and 10+ years in data analysis or process modeling, plus strong leadership and analytical skills. Expect collaboration across IT, compliance, and revenue teams and a drive to improve