Coordinator Risk Adjustment - 6

Coordinator Risk Adjustment R emote

Required Skills

• Healthcare Experience
• Claims Processing
• Administrative Experience
• Provider Relations
• Managed Care

Job Summary

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:

Responsibilities

• Coordinate chart retrieval projects by:
  • Ensuring that records are routed to appropriate resources.
  • Investigating all non-participating provider chart requests and escalating to the 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 (PHI) security protocols.
• Coordinate and schedule provider appointments to support risk adjustment education and audit reviews.
• Monitor the 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 the Subject Matter Expert (SME) 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 processes or vendor applications, interfacing with vendors as needed, and documenting/delivering resolutions.
• Maintain a thorough knowledge of risk adjustment programs across all supported lines of business (LOBs). Maintain and explore new provider EMR access for all LOBs.
• Serve as the point person for ordering, securing, and maintaining departmental supplies.

Skills

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

Other Skills

• Minimum of 3 years of experience in Claims, Managed Care, and/or a Healthcare environment with strong working knowledge of business computer programs, applications, and systems.
• Highly organized with strong written and verbal communication skills.
• Proficient in MS Excel, MS Access, and MS Word.
• Basic understanding of medical coding and health information data.
• 12 years of experience retrieving medical records from EMRs preferred.