Risk Adjustment Senior Chart Retrieval Specialist

Blue Cross and Blue Shield of Kansas•Topeka, KS

5d•$31 - $39•Hybrid

About The Position

The Senior Chart Retrieval Specialist is responsible for managing high-volume, complex, and audit-sensitive medical record retrieval operations in support of Affordable Care Act (ACA), Medicare Advantage (MA), Risk Adjustment (RA) and quality initiatives. This role operates with a high degree of autonomy and professional judgement overseeing daily retrieval activities, serves as a subject matter expert on chart retrieval systems and processes, supports provider relationships and escalations, and ensures data integrity, productivity, and audit readiness. The Senior Chart Retrieval Specialist identifies, assesses, and mitigates retrieval and documentation risk, partners closely with coding teams and management to protect audit outcomes and regulatory compliance. “This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Requirements

High School Diploma or equivalent is required
Minimum of 4 years of experience in medical record/chart retrieval, preferably in Risk Adjustment, HEDIS, or quality initiatives including experience handling complex or audit sensitive retrieval scenarios required
Demonstrated knowledge of CMS, MA, and HEDIS documentation requirements and compliance standards required
Proven experience managing provider relationships, handling escalations, and prioritizing high-volume workloads required
Demonstrated ability to interpret regulatory requirements and apply professional judgment to complex, non-standard retrieval scenarios
Manages complex and non-responsive provider outreach and escalations across multiple health systems
Demonstrates expert knowledge of CMS, ACA, and Medicare Advantage Risk Adjustment requirements
Builds and maintains strong relationships with provider offices and health system staff
Apply strong analytical and organizational skills to prioritize high-risk chases and manage timelines
Ensures strict adherence to HIPAA, CMS audit standards, and data security policies

Nice To Haves

2+ years' experience managing Risk Adjustment charts preferred
Prior experience training, mentoring, or supervising chart retrieval staff preferred
Familiarity with CMS audits (RADV), internal audits, or compliance reviews preferred
CPC/CRC Certification preferred

Responsibilities

Own daily chart retrieval operations, managing high volume and complex workloads while prioritizing work based on regulatory risk, data integrity, and submission timelines.
Coordinate maintenance and improvement to chart retrieval system with other internal stakeholders including Government Programs, Information Technology and Health Analytics.
Handle high-volume and/or complex provider networks, including coordination of special EMR/EHR integrations and access requirements.
Serve as the subject matter expert (SME) on chart retrieval systems, workflows, and procedures.
Train, mentor, and support Chart Retrieval Specialists by providing expert guidance on complex cases, quality standards, and compliance expectations, without formal supervisory responsibility.
Prepare and present project status updates to leadership, clearly communicating risks and issues and recommending mitigation strategies as needed.
Independently resolve high risk or delayed retrieval issues when within scope; escalate to management when issues exceed defined risk thresholds or require policy interpretation.
Collaborate closely with coding teams to ensure complete, accurate, and audit-ready medical record submissions.
Maintain accurate documentation to support internal reporting, audits, and regulatory compliance.
Coordinate and maintain mock-RADV process completion and reporting.