Risk Adjustment Reporting Specialist - SCMG Finance - Day Shift - Full Time

Hours:

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On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

What You Will Do
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 – in partnership with IT/Operations and under the direction of the Program Manager – to enable accurate documentation, complete submissions, and timely performance tracking. This position assists the Program Manager of Risk Adjustment with coordination and execution of approved strategies across population health/HCC initiatives. The role supports the auditing, reporting, and summarization of shared risk and related arrangements by assembling inputs, maintaining documentation, and coordinating with Finance and stakeholders to align settlement related reporting with contracted terms.

Required Qualifications

• 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.

Preferred Qualifications

• Bachelor's Degree
• Experience monitoring encounter/supplemental submissions and reconciliation processes.
• Certified Risk Adjustment Coder (CRC) - American Academy of Professional Coders (AAPC) -PREFERRED
• Certified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA) -PREFERRED

Other Qualification Requirements

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

Essential Functions

• Risk Adjustment Reporting and Submission
  Collaborate closely with Coding Auditors and the Data Analytics team to apply approved definitions, reconcile discrepancies, and ensure timely delivery of Risk Adjustment reporting.
  Serve, alongside the Program Manager, Risk Adjustment, as co project owner for value based care initiatives (e.g., the Annual Health Assessment program), coordinating timelines, deliverables, cross functional partners, and progress 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 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.
  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.
  Track vendor file timeliness/completeness (e.g., suspect files, supplemental/encounter status); escalate discrepancies and drive resolution.
  Support ad hoc report requests and produce concise, executive‑ready summaries of performance and operational impacts.
  Ensure alignment with Risk Adjustment policies/guidelines and maintain data integrity/privacy standards.
  Equip the Program Manager and leadership with clear, visually accessible insights and recommendations from risk adjustment data to inform decision making.
  Support the Program Manager, Risk Adjustment, in diagnosing data quality issues and coordinate assigned remediation activities; verify fixes and keep trackers/status current.
  Oversee/execute user acceptance testing (UAT) on reporting/analytical solutions to ensure requirements are met.
  Obtain risk adjustment financial impact summaries from Finance and incorporate the figures into program dashboards and leadership updates (Finance retains responsibility for all calculations and accounting entries).
  Organize and route vendor invoices for RA projects (e.g., Medicare Advantage retrospective chart review work) with appropriate backup so Finance can bill/charge the correct internal entities (e.g., SCMG, SHC) under established cost share arrangements; maintain a simple tracker for status and approvals.
• Reporting System and Solution Development
  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 future Risk Adjustment platform.
  Maintain awareness of IS initiatives/upgrades by participating in relevant committees/meetings.
  Assist RA Manager to develop and deliver training materials for new self‑service tools and applications; provide one‑to‑one support and point‑of‑use education for clients.
  Analyze client needs within system capabilities; recommend options and design reporting/programmatic solutions aligned to organizational priorities.
• Communication and Teamwork
  Gather feedback from clients/stakeholders on data and KPI needs; route to appropriate committees for prioritization and feasibility.
  Foster timely, collaborative relationships with internal and external clients that result in positive 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 cadence.
  Demonstrate teamwork in achieving departmental goals.
  Show willingness to help with any task to ensure departmental success.
  Work in a spirit of cooperation with all Sharp employees.

Knowledge, Skills, and Abilities

• Must have intermediate to advanced excel skills to include creating pivot tables, vlookups, etc.
• Is familiar with various reporting applications/tools such as Power BI/Tableau and SQL.
• Strong attention to detail, documentation discipline, and stakeholder communication.
• Familiarity with CMS/MA and ACA risk adjustment concepts, HCC hierarchies, RAF drivers, chart review/retrieval workflows, and coding audit support.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class