This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2229084 Government Programs SR Affordability Consultant

Work from home (telecommute) within Oregon, Washington, Idaho or Utah

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 GP Affordability Consultants are living our mission to make health care easier and lives better. As a member of the Medicare Performance & Affordability team, the Consultant is focused on reducing unnecessary medical expense for the Medicare Advantage, Medicare Supplement and Federal Employee Program lines of business. The individual in this role achieves actionable insights and suggests solutions using analytical and statistical methods, project management and business knowledge. Researches and evaluates programs and outcomes to determine performance against stated objectives. Documents and communicates recommendations and solutions to business partners - all in service of making our members\' health journeys easier.

If you\'re a data-driven and results-focused professional looking to make a difference in healthcare, apply for this exciting opportunity today!

What You Bring to Cambia:

PREFERRED KEY EXPERIENCE:

• 10 plus years of experience in health care and proficient with Facets

• Must have healthcare experience

• Regional Expertise

• Comfortable with provider specific intervention approaches

Qualifications:

• BA/BS degree in Business, Health Care Administration and/or social sciences or clinically related field
• Minimum of eight years of experience working with physicians or health plans
• Or equivalent combination of education and experience.

Skills and Attributes (Not limited to):

• Excellent oral, written, and presentation skills to effectively interface and communicate with customers.
• Demonstrated analytical ability to solve complex problems, develop solutions, and implement a chosen course of action with internal and external medical professionals and other experts.
• Facilitates or coordinates activities or projects, including the ability to identify business requirements, resolve issues, and build consensus among groups of diverse stakeholders.
• Strong organization skills, independent worker, and proficiency in Microsoft Office and various Web-based internet applications.
• Perform analyses on programs and initiatives and creates visual representations and summary reports of findings. Develops meaningful dashboards and presentations that use information to inform and influence business activities and strategies.

What You Will Do at Cambia (Not limited to):

• Interprets and applies claim editing system concepts including base and custom rule sets and capabilities into opportunity analysis.
• Leverages claims cost management knowledge to drive affordability including ideation to benefit realization.
• Identifies recovery opportunity and proposes tactical and strategic approaches to realize benefit.
• Applies deep knowledge of the Facets claim cycle process to identify potential opportunity in member, provider, medical code, and pricing logic.
• Interprets product benefit design and internal payment policy as part of opportunity analysis. Conducts research, presents findings, to inform and advise the policy team of potential opportunity.
• Utilizes Local and National Coverage Determinations as part of opportunity analysis.
• Applies knowledge of medical coding for professional, facility and ancillary billing to identify affordability opportunities in both prepayment and post payment settings.

The expected hiring range for the GP SR Affordability Consultant is 110k - 125k annually depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is \$103k Low Range / \$129k MRP / \$168k High Range.

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 co