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 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 (eligible day one of employment if within first 12 months following birth or adoption). 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 and Affirmative Action employer dedicated to workforce diversity and 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. Everyone is a health care consumer deserving of a simpler, more personalized experience. Cambia is transforming the health care system to revolve around people. For over 100 years we’ve designed people-first health solutions rooted in the nation’s first health plan, a loggers’ wage pool established in the Pacific Northwest. Today that pioneering spirit aligns our family of over 20 companies, including 4 not-for-profit BlueCross and BlueShield licensed health plans serving over 3 million Americans. Cambia blends data science with a compassionate human perspective to anticipate people’s needs, and empower them to make smarter health care choices. Interested in driving accessibility, affordability and quality health care for real people? Apply to any of our open jobs or join the Twitter conversation @Cambia. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.