Risk Adjustment Reporting Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• The Risk Adjustment Reporting Specialist plays a vital role in SCMG's Risk Adjustment program by generating, validating, and disseminating reports derived from both internal sources (such as EHR, claims, encounters/supplementals) and external vendor/health plan files.

• This position consolidates report intake, performs quality assurance checks, and manages distribution; collaborates with Coding Auditors and cross-functional teams to prepare data for stakeholder actions; and aids in the enhancement of the EHR and any prospective risk adjustment platforms.

• The role assists the Program Manager of Risk Adjustment in coordinating and implementing approved strategies across population health and HCC initiatives.

• Take ownership of and implement the Alternate Submission Method (ASM) process for Risk Adjustment submissions, which includes file preparation, validation checks, error remediation, documentation/attestations, and monitoring of submissions.

• Maintain trackers and create standard reports/dashboards (primarily using Excel; Power BI is preferred in collaboration with the Data Analytics team) for RAF trends, HCC suspect lists, coding close rates, chart retrieval/closure, and audit results.

⛳️ Requirements

• An Associate's Degree is required.

• A minimum of 3 years of progressively responsible experience in healthcare reporting/operations with direct exposure to Risk Adjustment (HCC/RAF).

• At least 1 year of experience working with various data sources (EHR, claims, encounters/supplementals) and types of health plan/vendor files (CSV/XLSX/flat files).

• Experience in executing or assisting with Risk Adjustment submission processes (e.g., ASM), including file validations and error remediation.

• A minimum of 1 year of experience with Excel, including the creation of pivot tables, vlookups, formulas, data cleansing, and more.

• Familiarity with reporting tools such as Power BI/Tableau and SQL.

• AAPC CRC, AHIMA, or a related certification is preferred.

🏝️ Benefits

• Competitive salary

• Comprehensive health benefits

• Opportunities for professional development and advancement

• Flexible work arrangements