Risk Adjustment Coordinator

Amerihealth Caritas•Philadelphia, PA

2d•Remote

About The Position

The Risk Adjustment Coordinator is responsible for supporting enterprise risk adjustment programs. This role involves coordinating chart retrieval projects, organizing and distributing documents and data files while maintaining Protected Health Information security protocols, and scheduling provider appointments for risk adjustment education and audit reviews. The coordinator will also monitor the central risk adjustment mailbox, run MS Access queries and MS Excel workbooks to track risk adjustment artifacts, and serve as a Subject Matter Expert for providers and other customers regarding risk adjustment programs and related applications. Additionally, the role requires maintaining knowledge of risk adjustment programs across all lines of business, exploring new provider EMR access, and managing departmental supplies.

Requirements

Minimum 3 to 5 years experience in Healthcare, Claims Processing, Administrative, Provider Relations and/or combination of experience.
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.
High School/GED Required.

Nice To Haves

1-2 year experience retrieving Medical Record from EMR preferred.

Responsibilities

Coordinate chart retrieval projects by ensuring records are routed to appropriate resources, investigating non-participating provider chart requests and escalating as needed, distributing documents and data files to providers, and monitoring through to resolution.
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.
Run and maintain basic MS Access queries and MS Excel workbooks to monitor risk adjustment related artifacts.
Serve as Subject Matter Expert for Providers, Provider Network Management and other customers regarding risk adjustment programs and related applications by researching issues, interfacing with vendors, and documenting/delivering resolution.
Maintain a thorough knowledge of risk adjustment programs across all supported lines of business.
Maintain and explore new provider EMR access for all LOBs.
Serve as point person for ordering, securing, and maintaining departmental supplies.