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New York, New York, United States
Hybrid
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 CMS’s 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 careers@Healthfirst.org or calling 212-519-1798 . In 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.
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620
All Other Locations (within approved locations): $61,300 - $89,440
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.
