Risk Adjustment Reporting Specialist
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Job Description
Risk Adjustment Reporting Specialist preparing, validating, and distributing reports from internal and external data sources at SCMG. Collaborating with Coding Auditors to support Risk Adjustment initiatives and submissions.
Responsibilities:
- 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.
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