Quality Improvement Risk Adjustment Retrieval Specialist

POSITION PURPOSE

• The Quality Improvement Retrieval Specialist is responsible for medical record chart retrieval between Client and medical services providers as well as performing Quality Assurance (QA) reviews and medical records per CMS, HHS, protocol, and NCQA guidelines.
• This position is accountable for complying with all laws, regulations, and accreditation standards that are associated with duties and responsibilities.

QUALIFICATIONS

Education

High school diploma or equivalent

Work Experience

• Experience in handling scheduling, coordination and retrieval of medical records, medical office administrative functions, along with customer facing is required
• Experience working in Electronic Medical Records (EMR)
• Minimum of 2 years of experience in reviewing/retrieving records for Risk Adjustment, HHS RADV, CMS RADV and/or HEDIS projects is preferred
• Experience in corporate office setting preferred

Skills and Abilities

• Ability to type minimum of 40 WPM with accuracy
• Ability to navigate through multiple computer programs with ease including but not limited to Microsoft Office Suite (Word, Outlook, Excel, etc.)
• Highly organized and efficient with strong attention to detail
• Ability to multitask and prioritize in a fast-paced, ever-evolving environment
• Excellent verbal and written communication skills
• Ability to interact effectively with all levels of staff

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• 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 CLientdatabases
• Handles telephone, email, and fax communication with provider offices and vendors to retrieve medical records and set up onsite medical record visits
• Documents conversations with provider offices and vendors, and tracks outcomes
• Scans and tags medical records into document management system
• Perform onsite medical record reviews
• Coordinate medical record requests with the association for all out of state medical record requests
• 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/STARS requirements
• Attends required meetings to stay current on departmental changes that relate to the duties/responsibilities of this position and the department as whole
• Other duties as assigned