Risk Adjustment Reporting Specialist

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🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $34.2k - $49.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💸 Financial Planning and Analysis (FP&A)

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Sharp HealthCare

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🧘 Wellness

Healthcare • Nursing • Wellness

Sharp HealthCare is a healthcare organization dedicated to providing high-quality medical services to patients and families. With a commitment to innovation, safety, and excellence, Sharp HealthCare offers a range of career opportunities in nursing, clinical support, administration, and various medical specialties. The organization emphasizes a collaborative work environment and is recognized for its nursing excellence, aiming to advance the science of medicine alongside compassionate patient care.

📋 Description

• The Risk Adjustment Reporting Specialist supports SCMG's Risk Adjustment program by preparing, validating, and distributing reports from internal sources (e.g., EHR, claims, encounters/supplementals) and external vendor/health plan files. • The role centralizes report intake, quality checks, and distribution; partners with Coding Auditors and cross functional teams to prepare information for stakeholder action; and supports optimization of the EHR and any future risk adjustment platform. • This position assists the Program Manager of Risk Adjustment with coordination and execution of approved strategies across population health/HCC initiatives. • 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. • Maintain trackers and develop standard reports/dashboards (primarily in Excel; Power BI preferred in coordination with the Data Analytics team) for RAF trends, HCC suspect lists, coding close rates, chart retrieval/closure, and audit outcomes.

🎯 Requirements

• Associate's Degree • 3 Years progressively responsible experience in healthcare reporting/operations with direct 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 Excel to include creating pivot tables, vlookups, formulas, data cleansing, etc. • Experience with reporting tools such as Power BI/Tableau and SQL. • AAPC CRC, AHIMA, or related certification is preferred.