• 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 development of provider risk adjustment training materials
• Perform other duties as assigned
• Ability to participate in an 80% remote work program.

• 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

• Bachelor’s Degree preferred, High School Diploma required.

• 1-2 years’ experience in a healthcare setting

Department: Risk Adjustment
This is a non-management position
This is a full time position