Clinical Coding Retrieval Coordinator

healthfirst; United States; Hybrid; USD 60,000 - 85,000; Full time

Job summary

Healthfirst seeks a Clinical Coding Retrieval Coordinator to support RADV medical records acquisition, regulatory compliance, and documentation accuracy. The role is provider facing and requires travel to provider sites in NYC metro and surrounding areas.

The position offers a hybrid work arrangement with remote, office-based, and field work as needed, including the 100 Church Street, New York location. Strong communication and organizational skills are essential.

Qualifications

• HS diploma or GED required.
• Associates degree preferred.
• Strong writing and communication skills essential.
• Proficiency in Microsoft Office Suite and Outlook required.
• Experience in medical records retrieval or health plan/provider setting preferred.

Responsibilities

• Support RADV medical records acquisition and regulatory requirements.
• Review medical records for RADV documentation alignment.
• Coordinate retrieval efforts with Compliance, Risk Adjustment, and HIM teams.
• Travel to provider sites to obtain records and ensure secure transmission.
• Maintain retrieval dashboards and provide status updates to stakeholders.
• Ensure HIPAA compliance and proper handling of PHI.

Skills

Writing

Time management

Communication

Problem solving

MS Office

Education

HS diploma or GED

Associates degree

Tools

Epic

eCW

Athena

Cerner

Job description

The Clinical Coding Retrieval Coordinator is responsible for supporting Healthfirst initiatives and regulatory requirements related to RADV medical records acquisition. This position is provider facing.

This position has a hybrid work location: Remote, office based, and in the field as needed. Office location is 100 Church Street, New York.

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 escal
• 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.

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