CareFirst Careers

Medical Record Retrieval Specialist

Resp & Qualifications

PURPOSE:
The Medical Record Retrieval Specialist is responsible for supporting the ACA Risk Adjustment team with primary accountabilities related to Medical Records Review (MRR) and provider outreach and relations. The Medical Record Retrieval Specialist will coordinate and implement activities supporting accurate and timely document management and retrieval efforts, adherence to regulatory and project timelines, and protection of the privacy of individuals’ health information according to HIPAA. Additional responsibilities include identification of process improvement activities, collaborating with multiple stakeholders at various levels throughout the Company, as well as external entities, providing coordination and support as required.

Under the supervision of the Supervisor, ACA Risk Adjustment, the principle duties and responsibilities include, but are not limited to, the following:

  • Conducts provider outreach and research to locate contact information of medical providers that may be practicing, retired, or otherwise relocated. Updates and maintains the Provider Database. Communicates professionally with medical facilities, third party vendors, and Company stakeholders.
  • Contacts provider offices with a high degree of professionalism and confidence to communicate expectations, charts required, etc. Establishes relationships with providers and ROI (Request of Information) vendors. Assists provider’s offices with the process of sending medical records. Educates, trains, provides support to provider’s staff on the different methods to send medical records. Analyzes and monitors progress of incoming correspondence including medical records to determine which organizations will need additional outreach. Identifies, investigates, and resolves issues related to incoming correspondence.
  • Develops tracking and monitoring methods for medical record requests. Manages and maintains medical records repository. Ensures accuracy, timeliness of record uploads, compliance with processes to protect PHI, and effective tracking of records and record requests. Performs processing tasks such as: sorting incoming mail, preparing documents for scanning, retrieving information from Right Fax, and moving documents as appropriate to the repository or vendor platform. Retrieval of medical records via fax, mail, remote electronic medical record access or onsite visits at the provider location. Use computer systems and applications for data entry, edits, and information retrieval.
  • Assumes a key role in the development of new processes and tracking systems to support best practice record keeping and document management procedures. Identifies process issues and contributes to the design of solutions. Proactively implements process improvements.
  • Ability to work under pressure and meet multiple deadlines. Effectively communicates with team members and external providers to ensure adherence with challenging project timelines. Assists internal team and provider groups to troubleshoot any logistical or technical issues regarding record requests or retrieval.
  • Completes additional tasks as required to support Risk Adjustment initiatives.

Qualification Requirements

Education and Experience
• Associates Degree in Healthcare Management or related field or equivalent work experience and a minimum 3 years of relevant experience with an insurance, managed care or healthcare organization.

Abilities/Skills:
• Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and Adobe Pro and demonstrated ability to learn/adapt to computer-based tracking and data collection tools
• Must be able to effectively communicate (oral and written) and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Strong organizational skills, ability to prioritize responsibilities with attention to detail.
• Must be self-motivated, able to take initiative, and work independently with minimal oversight to meet timelines, strong follow-through skills and a solutions-oriented attitude.
• Intermediate keyboard skills (typing, computer entry). Ability to work with multiple system applications simultaneously.
• Team player with ability to build and maintain relationships with cross-functional business partners, external partners, and others. Highly developed interpersonal skills.

Preferred:
• Knowledge of Risk Adjustment concepts
• Experience with TriZetto Facets
• Analysis and/or research experience with a complex system technology
• Recent document management experience. This includes knowledge and skills in using Adobe Pro, scanners, flash drives, Right Fax, navigating a shared drive and/or document repository and using software to track record requests.
Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly to Federal health care programs.


PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

 

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Department

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 3/6/2020

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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