Fraud Risk Oversight Director overseeing risk management programs at Truist. Leading teams to ensure efficient risk practices and compliance within the financial services sector.
About the role
- Provider Educator for Cambia’s Risk Adjustment team developing education initiatives for providers across Commercial and Medicare lines. Collaborating with the team to enhance provider engagement and optimize performance.
Responsibilities
- Develops, coordinates, and drives risk adjustment education initiatives with network providers.
- Acts as primary point of contact for assigned key provider engagements across Commercial and Medicare lines of business.
- Coordinate outreach, communication, training, and education for providers identified as candidates for provider education engagement.
- Work with key leaders within the provider organization to engage with and drive successful performance of the provider engagement.
- Assist senior leadership with special projects related to advancing Cambia’s value-based and innovative provider relationships.
- Participate in definition of project deliverables, providing consultation, recommendations, and solutions.
Requirements
- Bachelor’s degree in a related field.
- At least 5 years of Medicare Advantage or Commercial risk adjustment experience.
- At least 4 years of experience in a HCC Coding Audit or Network Management role or equivalent combination of education and experience.
- CPC and/or CRC credentials preferred.
- Strong consulting, communication (written and verbal), influencing, and facilitation skills.
- Proficiency in using Microsoft Office tools.
- Knowledge of health care industry trends, provider relations, and risk adjustment HCC coding, ICD10 diagnosis coding.
- Knowledge of health insurance preferred, including medical and dental terminology, procedural and diagnosis coding, reimbursement methodologies, and various provider network arrangements.
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.
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