Risk Adjustment Specialist
: Job Details :

Location Garden City, NY

Remote Available **Role: Risk Adjustment Specialist**

**Location: Garden City, NY (Hybrid-Remote)**

**Salary: $90,000 - $110,000**

**JOB SUMMARY:**

Risk Adjustment Specialist will be highly engaged, self-motivated, enthusiastic and service-oriented team member who will assist our network of primary care providers in identifying and resolving gaps in clinical documentation. The ability to work in a fast-paced environment while working with other teams as you continue to provide better health to countless numbers of patients.

**ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES:**

Daily responsibilities include but are not limited to:

* Work with third party vendor to maintain risk adjustment processes

* Support activities to identify risk adjustment strategies and tactics, and then to implement the activity sets (Medicare, Medicaid, Exchange, and Commercial)

* Assist with developing and delivering internal and external educational materials (including provider facing materials)

* Work with claims, enrollment and Medicare teams to resolve data submission errors from Encounter Data Processing System (EDPS)

* Review pended chart requests from vendor and work both internally and externally to assist in facilitating the retrieval of charts

* Assist in developing Risk Adjustment Data Validation (RADV) audit procedures and provide support in a RADV audit

* Assist in developing monthly and ad-hoc reports on risk adjustment project status, both financial and operational in nature

* Assist in developing Risk Adjustment departmental policies and procedures to support Risk Adjustment

* Understand and adhere to all Risk Adjustment regulations and deadlines set forth by CMS

* Perform monthly reconciliation of CMS File rejections

* Communicate and collaborate with medical coding team regarding risk adjustment projects

* Organize and complete internal projects related to risk adjustment coding and accuracy

* Assist in the development of provider risk adjustment training materials

* Perform other duties as assigned

**QUALIFICATION REQUIREMENTS:**

Skills, Knowledge, Abilities:

* Experience in using PC-based software packages, including relational database systems, spreadsheets, word processing

* Basic understanding of Medicare payment methodology

* Knowledge of various CMS and NYSDOH reports including:

* MMR, MOR, RAPS Return, EDPS, Plan payment reports

* 3M Medicaid reporting

* Excellent analytical skills

* Excellent written and oral communication skills

* Highly proficient with computer skills including working knowledge of Microsoft Office

* Highly organized

* Ability to deal with multiple internal and external resources

* Ability to handle tight timeframes and to meet multiple deadlines

**Training/Education:**

Bachelors Degree preferred, High School Diploma required.

**Experience:**

1-2 years experience in a healthcare setting