Clinical Coding Retrieval Coordinator

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 CMSs 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

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.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment please contact us by sending an email to or your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services LLC.

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Hiring Range*:

• Greater New York City Area (NY NJ CT residents): $68900 - $99620

• All Other Locations (within approved locations): $61300 - $89440

As a candidate for this position your salary and related elements of compensation will be contingent upon your work experience education licenses and certifications and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary Healthfirst offers employees a full range of benefits such as medical dental and vision coverage incentive and recognition programs life insurance and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in good faith would pay to a new hire or for a job promotion or transfer into this role.