Assistant Director Risk Adjustment Operations

Assistant Director Risk Adjustment Operations

Hybrid role (3 days/week in office) at our Portland, Medford, Fargo, Burlington, Spokane, Vancouver, Renton, Boise, Lewiston or Salt Lake City offices. Candidates must reside within commutable distance of that location.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

 Every day, Cambia’s dedicated team of Risk Adjustment professionals is living our mission to make health care easier and lives better. As a member of the Risk Adjustment  team, our Assistant Director Risk Adjustment Operations 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.

– 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. 

What You Bring to Cambia: 

Qualifications:

The AD Risk Adjustment Operations 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.

FTEs Supervised

• 6 - 20

Skills and Attributes: 

• 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.

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

​What You Will Do at Cambia:  

•  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.

Work Environment

• Work primarily performed in office environment.
• Travel may be required, locally, out of state, or internationally.
• May be required to work outside normal hours.

Oregon, Washington, Utah, and Idaho: The expected hiring range is $121,600.00 – $164,500.00, the full salary range is $114,000.00 – $186,000.00. and the bonus target is 15%.

North Dakota: The expected hiring range is $128,145.07 - $173,372.75,  the full salary range is $113,780.47 - $187,737.35 and the bonus target is 15%.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:  

• Work alongside diverse teams building cutting-edge solutions to transform health care.  
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.  
• Grow your career with a company committed to helping you succeed. 
• Give back to your community by participating in Cambia-supported outreach programs.  
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.  

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: 

• 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. 

Learn more about our benefits. 

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a 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.

We are an Equal Opportunity employer dedicated to 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.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.