Location: New York,NY, USA
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