Clinical Coding Retrieval Coordinator

HealthFirst•New York, NY

6d•$68,900 - $99,620•Hybrid

About The Position

The Clinical Coding Retrieval Coordinator supports Healthfirst initiatives and regulatory requirements related to RADV medical record acquisition. This is a provider-facing role with a hybrid work location involving remote work, office work, and field work as needed. The office is located at 100 Church Street, New York. The coordinator supports retrieval and review of medical records, helps ensure compliance with CMS RADV documentation requirements, and coordinates with providers, hospitals, and internal teams to meet regulatory deadlines. The role also tracks retrieval progress, manages facility-level issues, communicates project updates, prepares status presentations, and protects the security of PHI.

Requirements

High school diploma or GED from an accredited institution.
2–3 years of experience in medical record retrieval in a health plan or provider setting, or administrative experience in lieu of experience in a health care setting.
Strong writing, time management, critical and 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, Long Island, New Jersey, Connecticut, and Pennsylvania as necessary.
Strong attention to detail.
Ability to manage high-volume workflows with extreme attention to detail and tight deadlines.

Nice To Haves

Associate degree or higher from an accredited institution.
Prior experience in managed care or health insurance, or in a health-related field or environment.
Proficiency with multiple EMR systems, such as Epic, eCW, Athena, or Cerner.
Understanding of CMS RADV requirements and medical record documentation best practices.
2–3 years of experience with chart requests and 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.
Proven experience engaging and coordinating with provider offices and hospital HIM departments.

Responsibilities

Expand and improve medical records acquisition for the RADV risk adjustment program.
Review medical records to ensure they are consistent with RADV clinical documentation specifications.
Conduct medical record retrieval for RADV and internal audit activities.
Work cross-functionally with Compliance, Risk Adjustment, and HIM teams at provider and hospital sites to meet CMS retrieval deadlines.
Ensure medical records are accurately accounted for, scanned, and saved in the appropriate Healthfirst system.
Ensure compliance with CMS RADV medical record documentation requirements.
Track retrieval progress, maintain dashboards, and proactively escalate risks or delays.
Maintain collaborative relationships with medical facilities through strong communication.
Travel to providers’ sites and hospitals to obtain medical records.
Manage facility-level issues to facilitate medical records acquisition.
Coordinate multiple audit requests simultaneously.
Provide detailed updates on regulatory audits, projects, and initiatives to internal stakeholders during status update meetings.
Organize and prepare PowerPoint presentations for project status reports.
Maintain HIPAA compliance and ensure secure transmission of all PHI.
Perform additional duties as necessary.