Clinical Coding Retrieval Coordinator

Description and Requirements

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 escalate 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

• 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.

• 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

• 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