Duties:
100% work at home. Mon - Fri 7am-3:30pm EST


Quality Review & Audit Senior Representative *** IFP Risk Adjustment



Job Summary:


The position supports ***'s Risk Adjustment program and is responsible for medical record chart retrieval and administration. This role is responsible for auditing, and problem-solving issues pertaining to retrieving and processing medical records.


Core Responsibilities:



Monitors all chart retrieval activities for chart retrieval projects, and performs actions as defined by department workflows, including tracking outstanding records, analyzing barriers to retrieval, evaluating chart availability, reviewing for completeness & image quality, routing charts to the appropriate location, problem solving with retrieval vendors, and recording activities in the designated application.

Performs outreach via telephone or secure fax to provider offices for requests including but not limited to additional information required, record delivery, retrieved record deficiencies, and signature deficiency attestation completion, as needed.

Day to day quality audits on vendor chart records, responses, provider engagement, and related requirements.

Ensures confidentiality and security of *** customer PPI/PHI by following all HIPAA, regulatory, and *** processes and release-of-information protocols.

Follows *** medical records policies for storage and retention.

Maintains a daily production tracker, or other reporting, in a predetermined format and cadence.

Performs chart processing, vendor pend resolution, provider research, and other tasks as required to execute on Risk Adjustment programs.


Minimum Qualifications:

High School Diploma or equivalent

Prior experience with working with EMR/EHR systems

Knowledge of medical records, including basic medical terminology

Strongly skilled in Microsoft Excel, Outlook management, Adobe and Word.

Ability to manage time and tasks throughout your day efficiently in a virtual environment.

Ability to determine when chart or site escalations are required to resolve issues.

Ability to work as a team and individually on time-sensitive projects.

Ability to perform work in an accurate and timely manner.

Must be detail oriented, able to multi-task, accurate in data entry, able to follow directions, and apply criteria for multiple measures.

General understanding of healthcare privacy regulations.

Demonstrates clear, concise, and professional communications with peers and supervisors, in verbal, telephonic, and written communication.

Demonstrates the ability to follow workflows independently as required.

Prior experience with working with medical records preferred.

Experience with HCC coding preferred but not required.


non-negotiable skills:
Proficient in Excel, Outlook, Word, EMR experience, healthcare/medical records background

education requirements:
High School Diploma or equivalent
Skills:
Microsoft Office Suite - Excel, PowerPoint, Word, etc.
Medical Record EMR use
Customer Service/Professionalism
Education:
HS Diploma
Languages:
English Read Write Speak