Clinical Coding Retrieval Coordinator

Healthfirst; Layton (UT); On-site; USD 61,000 - 89,000; Full time

Job summary

Healthfirst is seeking a detail-oriented Records Retrieval Specialist to support RADV risk adjustment. You will expand and optimize processes for obtaining medical records, review documentation for CMS RADV alignment, and coordinate audits with Compliance, Risk Adjustment, and HIM teams across multiple provider sites.

The role requires 2–3 years in medical record retrieval, strong writing and communication skills, and proficiency with Microsoft Office.

Qualifications

• HS diploma or GED from an accredited institution.
• 2–3 years in medical record retrieval in a health plan/provider setting.
• Strong writing, time management, communication and problem-solving skills; MS Office proficiency.

Responsibilities

• Expand and improve medical records acquisition for RADV risk adjustment.
• Review medical records for RADV compliance with CMS specifications.
• Engage in medical record retrieval efforts for RADV and internal audits.
• Collaborate with Compliance, Risk Adjustment, and HIM teams across provider sites to meet CMS deadlines.
• Ensure medical records are accurately accounted for, scanned, and stored securely.
• Maintain HIPAA compliance and secure transmission of PHI.
• Travel to providers’ sites to obtain medical records.
• Prepare status updates and presentations for stakeholders.

Skills

Strong writing

Time management

Communication

Problem solving

Education

HS diploma or GED

Associates degree or higher

Tools

Microsoft Office Suite

Outlook

Epic

eCW

Athena

Cerner

Job description

Duties & Responsibilities

• Responsible for expanding and improving medical records acquisition for RADV risk adjustment program
• Performs medical record reviews to ensure medical records are consistent with RADV clinical documentation specifications
• Engages in medical record retrieval efforts for RADV and internal audit activities
• Works cross-functionally with Compliance, Risk Adjustment, and HIM teams at different providers and hospitals sites to meet CMS’s retrieval deadlines
• Ensures medical records are accurately accounted for, scanned, and saved in the appropriate Healthfirst system
• Ensures compliance with CMS RADV medical record documentation requirements
• Tracks retrieval progress, maintain dashboards, and elevate risks or delays proactively
• Strong communication skills are a must in order to maintain collaborative relationships with medical facilities
• Travels to providers’ sites and hospitals to obtain medical records
• Manages issues at a facility level in order to facilitate medical records acquisition
• Coordinates multiple audit requests at the same time
• Provides detailed updates on regulatory audits, projects, and initiatives to internal stakeholders during status updates meetings
• Organizes and prepares PowerPoint presentations for project status reports
• Maintains HIPAA compliance and ensure secure transmission of all PHI
• Additional duties as necessary

Minimum Qualifications

• HS diploma or GED from an accredited institution
• 2-3 years in medical record retrieval in a health plan/ provider setting or administrative experience in lieu of health care setting
• Strong writing, time management, critical/creative thinking, communication, and problem-solving skills
• Strong working knowledge of Microsoft Office Suite and Outlook
• Ability to travel around the NYC metro area, Westchester and Long Island as well as New Jersey, Connecticut and Pennsylvania as necessary

Preferred Qualifications

• Associates degree or higher from an accredited institution
• Prior experience in Managed Care/Health Insurance, in a health-related field or environment
• Proficiency in multiple EMR systems (Epic, eCW, Athena, Cerner, etc)
• Understanding of CMS RADV requirements and medical record documentation best practices
• 2-3 years of experience with chart requests/retrievals using Risk Adjustment modeling
• 2-3 years of experience identifying SOAP notes for different specialties in a hospital, physician, or insurance environment using Risk Adjustment, Commercial, and CRG Models

Additional Job Description

• Strong attention to detail
• Familiar with multiple EMR systems
• Proven experience engaging and coordinating with provider offices and hospital HIM departments
• Ability to manage high-volume workflows with extreme attention to detail and tight deadlines
• Compliance & Regulatory Responsibilities: Noted above
• License/Certification: N/A

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status or unemployment status, as well as any other legally protected basis.

HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*

Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620 All Other Locations (within approved locations): $61,300 - $89,440

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements).

Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well-being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you.