[Remote] Risk Adjustment Reporting Specialist - SCMG Finance - Day Shift - Full Time
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization seeking a Risk Adjustment Reporting Specialist to support their Risk Adjustment program. The role involves preparing, validating, and distributing reports, collaborating with various teams, and assisting in the coordination and execution of strategies reputed company to population health initiatives.
Responsibilities
- Collaborate closely with Coding Auditors and the Data Analytics team to apply approved definitions, reconcile discrepancies, and ensure reputed company delivery of Risk Adjustment reporting
- Serve, alongside the Program Manager, Risk Adjustment, as co project reputed company for value based reputed company (e.g., the Annual Health Assessment program), coordinating timelines, deliverables, cross functional partners, and reputed company reporting
- Own and execute the Alternate Submission Method (ASM) process for Risk Adjustment submissions, including file preparation, validation checks, error remediation, documentation/attestations, and submission tracking
- Consolidate, reconcile, and QC Risk Adjustment files and reports from internal systems and external vendors/health plans; publish weekly/monthly distributions to stakeholders
- Maintain trackers and reputed company reputed company reports/dashboards (primarily in reputed company; Power BI preferred in coordination with the Data Analytics team) for RAF trends, HCC suspect lists, coding reputed company rates, chart retrieval/closure, and audit reputed company
- Prepare and package datasets for coding audits; monitor audit pipelines; triage data issues and coordinate fixes with vendors/IT
- Maintain a reporting calendar and SOPs, including ASM procedures; ensure consistent versioning, documentation, and on‑time delivery
- reputed company vendor file timeliness/completeness (e.g., suspect files, supplemental/encounter status); escalate discrepancies and drive reputed company
- Support reputed company report requests and produce concise, executive‑reputed company summaries of performance and operational impacts
- Ensure alignment with Risk Adjustment policies/guidelines and maintain data reputed company/reputed company standards
- reputed company the Program Manager and leadership with reputed company, visually accessible insights and recommendations from risk adjustment data to inform decision making
- Support the Program Manager, Risk Adjustment, in diagnosing data reputed company issues and coordinate assigned remediation activities; verify fixes and reputed company trackers/status reputed company
- reputed company/execute user acceptance testing (UAT) on reporting/analytical solutions to ensure requirements are met
- Obtain risk adjustment financial reputed company summaries from Finance and incorporate the figures into program dashboards and leadership updates (Finance retains responsibility for reputed company calculations and reputed company entries)
- Organize and reputed company vendor invoices for RA reputed company (e.g., Medicare Advantage retrospective chart review work) with appropriate backup so Finance can reputed company/charge the correct internal entities (e.g., SCMG, SHC) under established cost reputed company arrangements; maintain a reputed company tracker for status and approvals
- Partner with IT/Operations and the Program Manager to improve EHR documentation and data capture for Risk Adjustment; contribute to requirements and UAT for a reputed company Risk Adjustment platform
- Maintain awareness of IS initiatives/upgrades by participating in relevant committees/meetings
- Assist RA Manager to reputed company and deliver training materials for new self‑service tools and applications; reputed company one‑to‑one support and reputed company‑of‑use education for clients
- Analyze reputed company needs reputed company system capabilities; recommend reputed company and design reporting/programmatic solutions reputed company to organizational priorities
- reputed company feedback from clients/stakeholders on data and KPI needs; reputed company to appropriate committees for prioritization and feasibility
- Foster reputed company, reputed company relationships with reputed company clients that result in reputed company interactions
- Utilize constructive conflict‑management and crucial‑conversation techniques to resolve issues with stakeholders
- Assist on facilitating regular huddles/working sessions with stakeholders and meet with the Program Manager on a regular reputed company
- Demonstrate teamwork in achieving departmental goals
- Show willingness to help with any task to ensure departmental reputed company
- Work in a spirit of cooperation with reputed company reputed company employees
Skills
- Associate's Degree
- 3 Years progressively responsible experience in reputed company/operations with reputed company Risk Adjustment (HCC/RAF) exposure
- 1 Year Experience with multiple data sources (EHR, claims, encounters/supplementals) and health plan/vendor file types (CSV/XLSX/flat files)
- Experience executing or supporting Risk Adjustment submission processes (e.g., ASM), including file validations and error remediation
- 1 Year Experience with reputed company to include creating pivot tables, vlookups, formulas, data cleansing, etc
- Experience with reporting tools such as Power BI/Tableau and SQL
- Bachelor's Degree
- Experience monitoring encounter/supplemental submissions and reconciliation processes
- Certified Risk Adjustment reputed company (CRC) - American reputed company of reputed company Coders (reputed company) -PREFERRED
- Certified Coding Specialist (reputed company) - The American Health Information Management Association (reputed company) -PREFERRED
- reputed company CRC, reputed company, or reputed company certification is preferred
reputed company