Risk Adjustment Reporting:

Generate and maintain regular and ad-hoc reports on risk adjustment data, including but not limited to HCC RAF (Risk Adjustment Factor), and CMS data.

Develop, monitor, and automate reports that track trends, performance metrics, and benchmarks for risk adjustment activities.

Data Analysis:

Analyse and validate risk adjustment data, identifying discrepancies, and performing data reconciliations to ensure accuracy and completeness. Interpret complex healthcare data to derive insights and recommend actions based on findings.

Compliance and Accuracy: Ensure reports are following CMS regulations, policies, and contractual obligations.

Collaborate with internal teams to ensure proper risk adjustment processes are followed.

Collaboration with Stakeholders:

Work closely with healthcare professionals, internal departments, and external partners to gather and report risk adjustment data.

Communicate findings to leadership and other stakeholders in a clear and concise manner.

System & Tool Management:

Utilize advanced reporting tools, such as SQL, Excel, and business intelligence platforms, to generate and manage risk adjustment reports.

Contribute to the enhancement and optimization of risk adjustment data tools and processes.

Data Integrity & Quality Control:

Perform quality control on data inputs and outputs to ensure the integrity of risk adjustment metrics. Document reporting procedures, ensuring that processes are repeatable and reliable.