RADV Medical Records Retrieval Specialist

HealthFirst; New York (NY); Hybrid; USD 69,000 - 100,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Incentive and recognition programs

Life insurance

401k contributions

Job summary

Healthfirst is seeking a Clinical Coding Retrieval Coordinator to support RADV medical records acquisition and regulatory requirements. This hybrid role covers remote work, a New York office location at 100 Church Street, and field visits as needed.

You will expand RADV records retrieval, review records for CMS RADV alignment, and coordinate cross-functional teams to meet deadlines. Strong communication and HIPAA compliance are essential for success in this provider-facing position.

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 Islandas well as New Jersey, Connecticut and Pennsylvania as necessary.
• 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

Responsibilities

• Expand and improve medical records acquisition for RADV risk adjustment program
• Performs medical record reviews to ensure 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 to maintain collaborative relationships with medical facilities
• Travels to providers’ sites and hospitals to obtain medical records
• Manages issues at a facility level to facilitate medical records acquisition
• Coordinates multiple audit requests at the same time
• Provides 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

Skills

Strong writing

Time management

Critical thinking

Communication

Problem solving

MS Office

Education

HS diploma or GED

Associates degree or higher

Tools

Epic

eCW

Athena

Cerner

Job description

Healthfirst is seeking a Clinical Coding Retrieval Coordinator to support RADV medical records acquisition and regulatory requirements. This hybrid role covers remote work, a New York office location at 100 Church Street, and field visits as needed.

You will expand RADV records retrieval, review records for CMS RADV alignment, and coordinate cross-functional teams to meet deadlines. Strong communication and HIPAA compliance are essential for success in this provider-facing position.