[Hiring] Risk Adjustment Reporting Specialist @Sharp HealthCare

Role 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 – 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.

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.

Requirements

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

Essential Functions

• 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.
• 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.
• 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.