Risk Adjustment Medical Record Review Specialist

This position is responsible for medical record chart retrieval on between Blue Cross Blue Shield of Louisiana and medical services providers as well as performing QA reviews on medical records per CMS HHS protocol and NCQA guidelines. Accountable for complying with all laws regulations and accreditation standards that are associated with duties and responsibilities.

• This role does not manage people
• This role reports to this job: Departmental Leadership
• Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:
  
  All levels of BCBSLA personnel; physicians and their office personnel; hospitals and allied health provider administration personnel and third party medical record vendors ; other Blue Plans; BCBS Association and contracted vendors.

• High School Diploma required

• Minimum of 2 years of experience in reviewing / retrieving records for Risk Adjustment and HEDIS projects required
• CMS and HHS medical records review protocol guidance and/ or measure guidance for NCQA measures experience required. Experience doing medical records scheduling coordination and retrieval medical office administrative assistant or other customer-facing experience.

• Must have the ability to travel up to 40% of the time to provider offices as directed by management
• Must have excellent PC skills including MS Word Outlook PowerPoint and advanced Excel.
• Excellent verbal and written communication skills are required.
• Understanding of risk adjustment and/or HEDIS

• None Required

• Queries and identifies relevant medical records within (but not limited to) document management system care management system and vendor(s) databases to be uploaded into BCBSLA databases.
• Handles telephone email and fax communication with provider offices and vendors to retrieve medical records and setup onsite medical records visits.
• Documents conversations with provider offices and vendors and tracks outcomes. Scans and tags medical records into document management system.
• Perform onsite medical record review and abstract needed information to be uploaded into BCBSLA database.
• Coordinate medical records request with the Blue Cross Blue Shield Association for all out of state medical record request
• Perform QA Reviews on all medical records to ensure records meet CMS and HHS documentation requirements as well as retrieve medical records that meet specific NCQA requirements.

• Perform other job-related duties as assigned within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend document calculate visualize and analyze are required.

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