The Risk Adjustment Practitioner, RAP

The Benefits

The RAP Certification indicates an in-depth comprehension achieved by a professional of best practices, processes and strategies for risk-based payment programs including health plans, ACA issuer, providers and ACOs.

The Risk Adjustment Practitioner Certification is appropriate for all levels of professional positions: staff, management, or leadership, practicing in the fields of:

• data analytics
• program management
• revenue quality
• revenue management
• all levels of management
• actuarial services
• HCC coding / documentation
• HEDIS and quality
• auditing / compliance
• other related roles

Risk Adjustment Practioner Certification indicates a level of mastery in the following areas:

• The History of Risk Adjustment
• The Policy Goals for the Medicare Advantage and HHS Marketplace risk adjustment programs
• The methods used in creating risk adjustment factor scores that drive financial calibration of payment rates
• The Operations implications - the workflow sequencing and dependencies that link to payment streams, annual work and program cycles, and payer / provider interactions
• The complications of Multi-program interactions – the linkages between risk adjustment programs and activities with those of Stars / Quality / HEDIS
• The Provider relations and provider education elements critical for effective program management
• The Mitigation strategies utilized for Compliance and Risk insuring security
• The Connection between coding and chart documentation at the provider level and the RADV program
• The overall approach for Risk adjustment program management, utilizing best practices to manage risk adjustment and revenue at the payer and provider levels