Healthfirst is a New York health insurance provider serving individuals and families with coverage options across Medicaid managed care, Medicare Advantage, long-term care, and Essential Plans. The company has more than 30 years of experience in healthcare insurance, with a focus on helping members access affordable coverage and support for their health needs.
Clinical Coding Retrieval Coordinator
Coordinate medical record retrieval and review for Healthfirst’s RADV risk adjustment and compliance programs. Work with providers and internal teams to track audits, meet deadlines, and protect HIPAA-regulated documentation.
Apraksts
- Support Healthfirst programs and regulatory obligations involving RADV medical record acquisition
- Improve records acquisition for the RADV risk adjustment program
- Review records against RADV clinical documentation specifications
- Retrieve records for RADV and internal audits
- Coordinate with provider and hospital Compliance, Risk Adjustment, and HIM teams to meet CMS deadlines
- Log, scan, and store records in the appropriate Healthfirst system
- Verify records meet CMS RADV documentation requirements
- Monitor retrieval progress, update dashboards, and flag risks or delays
- Visit provider and hospital sites to collect records
- Resolve facility-level issues that affect records acquisition
- Handle several audit requests at once
- Update internal stakeholders on regulatory audits, projects, and initiatives
- Prepare PowerPoint presentations for project status reports
- Protect HIPAA compliance and transmit PHI securely
- Carry out other duties as needed
Prasības
- High school diploma or GED from an accredited institution
- Two to three years of medical record retrieval experience in a health plan or provider setting, or equivalent administrative experience outside healthcare
- Strong writing, time management, critical and creative thinking, communication, and problem-solving skills
- Working knowledge of Microsoft Office and Outlook
- Ability to travel as needed throughout the New York City metro area, Westchester, Long Island, New Jersey, Connecticut, and Pennsylvania
- Preferred: associate degree or higher from an accredited institution
- Experience in managed care, health insurance, or another health-related setting
- Proficiency with multiple EMR systems such as Epic, eCW, Athena, or Cerner
- Understanding of CMS RADV requirements and medical record documentation practices
- Two to three years of chart request and retrieval experience using risk adjustment models
- Two to three years of experience identifying specialty SOAP notes in a hospital, physician, or insurance setting using Risk Adjustment, Commercial, and CRG models
- Strong attention to detail
- Experience coordinating with provider offices and hospital HIM departments
- Ability to manage high-volume workflows accurately under tight deadlines
Priekšrocības
- Medical, dental, and vision coverage
- Incentive and recognition programs
- Life insurance
- 401(k) contributions
- Competitive compensation and benefits package