Risk Adjustment Coordinator

Duties

Under the general direction of the Manager, Risk Adjustment Coding Quality, the Coordinator Risk Adjustment is responsible for supporting enterprise risk adjustment programs by completing the following duties

Coordinate chart retrieval projects by

• Ensuring that records are routed to appropriate resources.
• Investigating all non-participating provider chart requests and escalating to appropriate resource as needed.
• Distributing related documents and data files to providers and monitoring through to resolution.
• Escalating issues in a timely manner to ensure deliverables and due dates are maintained.
• Organize and coordinate the production, distribution, storage and archiving of documents and data files while maintaining Protected Health Information security protocols.
• Coordinate and schedule provider appointments to support risk adjustment education and audit reviews.
• Monitor central risk adjustment mailbox and route correspondence to appropriate associates within the department.
• Run and maintain basic MS Access queries and MS Excel workbooks to monitor risk adjustment related artifacts that support the program.
• Serve as Subject Matter Expert for Providers, Provider Network Management and other customers regarding risk adjustment programs and related applications (e.g., NaviNet, vendor chart retrieval application, etc.) by researching issues with internal process or vendor applications, interfacing with vendors as needed, and documenting/ delivering resolution.
• Maintains a thorough knowledge of risk adjustment programs across all supported lines of business.  Maintains and explores new provider EMR access for all LOBs.
• Serves as point person for ordering, securing and maintaining departmental supplies.

Skills

• Minimum 3 to 5 years’ experience in Healthcare, Claims Processing, Administrative, Provider Relations and/or combination of experience.

Other Skills

• Minimum of 3 years’ experience in Claims, Managed Care and/or Healthcare environment with strong working knowledge of business computer programs, applications and systems required.
• Highly organized with strong written and verbal communication skills.
• Proficient with MS Excel, MS Access and MS Word.
• Basic understanding of medical coding and health information data required.
• 1-2 year experience retrieving Medical Record from EMR preferred.