Risk Adjustment Medical Record Retrieval Specialist

MetroPlus; New York (NY); On-site; USD 65,000 - 90,000; Full time

Job summary

MetroPlus on-site in New York seeks a Risk Adjustment Medical Record Retrieval Specialist to lead retrieval efforts, liaison with facilities and vendors, and build digital filing systems. You will access EHR, drop-box, eFAX, and email platforms, ensure data integrity, and use HIT standards to classify charts and validate encounters.

The role requires a Bachelor’s in health information administration or HIT and 3 years in a health plan or provider setting, with strong communication and analytical

Qualifications

• Bachelor's degree in health information administration or HIT, plus 3 years experience.
• HIT program approved by AHIMA or CAHIIM preferred.
• Experience with health plans or medical providers.

Responsibilities

• Establish and maintain ongoing contact with medical facilities and retrieval vendors to facilitate record retrieval.
• Create systems for categorizing and organizing medical records for long-term digital storage.
• Plan and execute retrieval projects, including identifying high-volume sites and setting retrieval goals.
• Access EHR systems, remote drop-boxes, electronic fax, and email to retrieve and save medical records.
• Apply HIT standards to identify proper chart types and valid encounters.
• Use data elements (date of service, provider type, demographics) to validate provider visits and request corrections if needed.
• Coordinate transmission of medical records across partners while ensuring documentation integrity and identifying gaps for complete chart reviews.
• Use analytics software (e.g., Excel, MySQL) to analyze retrieval project results and inform future designs.
• Identify acceptable stand-alone documentation and evaluate supporting documentation for validation of risk adjustment diagnoses.

Skills

Attention to detail

Communication skills

Analytical mindset

Education

Bachelor's degree in health information administration or HIT

Tools

Excel

MySQL

Job description

Position Overview

The Risk Adjustment Medical Record Retrieval Specialist will lead efforts to improve the retrieval of medical records for our risk adjustment program. You will establish and maintain contact with medical facilities and retrieval vendors to achieve success and accuracy in the retrieval or targeted medical records. You must have strong attention to detail and a knack for creating systems to store and organize records digitally. You will need to obtain access and retrieve records from a variety of digital platforms, including EHR systems and remote drop-boxes, as well as digital fax and e-mail. Strong communication skills are a must in order to maintain collaborative relationships with medical facilities and our retrieval vendors.

Scope of Role & Responsibilities

• Establish and maintain ongoing contact with medical facilities. Triage issues at each facility in order to facilitate the retrieval of records.
• Create systems or categorizing and organizing medical records for long-term digital storage.
• Create and execute plans for specific retrieval projects, including identifying high-volume sites, setting retrieval goals and working with internal staff and external vendors to achieve retrieval goals.
• Access various retrieval systems, including remote EHR systems, electronic drop-box and eFAX systems to retrieve and save medical records.
• Use Health Information Technology (HIT) standards to identify proper chart types and valid encounters.
• Use various data elements (incl. date of service, provider type, demographic information, etc) to validate provider visits. Work with facilities to request corrected medical records when necessary.
• Coordinate the transmission of medical records across various partners while ensuring documentation integrity through the identification of gaps necessary for a complete chart review.
• Use analytic software (i.e. Excel or MySQL) to analyze the results of retrieval projects – draw conclusions and insights from data to help inform the design of future projects.
• Identifies acceptable stand-alone documentation and evaluates supporting or supplemental documentation used to validate risk adjustment diagnoses and findings. Reviews the documentation for chart deficiencies and completeness.

Required Education, Training & Professional Experience

• Bachelor's degree required, preferably in health information administration (HIA) or health information technology (HIT); and three (3) years of experience working at a health plan or medical provider/facility.
• Medical record technology or health information technology (HIT) program approved by a nationally accredited agency (e.g., AHIMA or CAHIIM) preferred.

Professional Compentencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication