Mgr Risk Management Business Team

Cambia Health Solutions • Salt Lake, UT

6d • Hybrid

About The Position

Every day, Cambia’s dedicated Risk Management Business Team Manager is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Management Business Team Manager is responsible for complying with CMS mandates to submit Enrollment, Medical Claim and Pharmacy Claim data for Reinsurance and Risk Adjustment programs. Leads a team dedicated to extracting required information from the source systems into a staging area, performing validation checks based on CMS Edge Server Business Rules, and submitting correct data to the Edge Server via a translation process. – 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.

Requirements

• Bachelor’s degree in Business, Data Analysis or other related field
• 10 years’ experience with data analysis, process modeling or equivalent combination of education and experience.
• Strong analytical skills including the ability to analyze complex data and situations, learn quickly and synthesize corresponding solutions, options and action plans.
• Ability to understand, translate and communicate complex ideas and situations to a wide variety of audiences.
• Excellent research and problem solving skills including the ability to determine action steps and remediation actions to resolve issues.
• Strong knowledge of risk adjustment systems and processes.
• Demonstrated experience in business areas, working with business requirements, documentation and data systems.
• Strong knowledge of project management processes and practices including experience leading large, complex initiatives.
• Knowledge of medical terminology and procedure coding.
• Ability to communicate effectively verbally and in writing with all levels of staff.
• Ability to develop and lead a team including: hiring, goal setting, motivating, coaching and staff development.
• Wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
• Access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company.

Nice To Haves

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

Responsibilities

• Corroborates closely with the IT, compliance, legal, revenue management, claims, enrollment, product teams and other departments to maximize and maintain submission measurements
• Helps oversee RADV audits, submits data in a timely manner and prepares executive reports.
• Develops medical underwriting rules for the Risk Management business 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.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager