Job Details

We are seeking a dedicated professional to join our team, responsible for interacting with provider offices, clinics, and other healthcare facilities to ensure the efficient retrieval and management of medical records. This role is critical in supporting HEDIS/QARR and other focused audits/studies, providing guidance on protocols, and ensuring compliance with industry standards.

Key Responsibilities

• Engage directly with healthcare providers to facilitate the retrieval of medical records for comprehensive review and abstraction.
• Schedule and conduct onsite medical record reviews with high-volume providers to ensure compliance with HEDIS/QARR standards.
• Evaluate discrepancies in documentation during initial reviews and recommend corrective actions.
• Enter and manage documentation findings in a centralized database, working closely with providers to retrieve medical records per CMS Risk Adjustment criteria.
• Assist in retrieving medical records for various Risk Adjustment and Quality projects, including Retrospective Review and RADV audits.
• Organize and manage retrieved medical records in a central repository, ensuring accurate data entry and scanning of relevant components.
• Safeguard the confidentiality of medical charts/records, adhering to local, state, and federal laws, including HIPAA regulations.
• Educate providers and office staff on the criteria for medical records eligible for Risk Adjustment according to CMS guidance.
• Participate in required training sessions and assist in quality improvement audits, surveys, and focused studies as necessary.
• Escalate unresolved medical record retrieval issues to the manager and follow up on outstanding issues identified during reviews.

• Strong understanding of HEDIS/QARR standards and CMS Risk Adjustment criteria.
• Excellent organizational skills with the ability to manage a large volume of records efficiently.
• Proficiency in data entry and experience with database management.
• Attention to detail and ability to identify and address discrepancies in documentation.
• Strong communication skills to effectively educate and guide providers and office staff.
• Knowledge of HIPAA regulations and commitment to maintaining confidentiality.
• Ability to work independently and collaboratively in a fast-paced environment.
• Experience in healthcare settings or medical records management is preferred.