Medical Retrieval and Risk Adjustment Consultant

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the collection, organization, assessment, and submission of medical records for risk adjustment audits, HEDIS reviews, RADV audits, and other compliance efforts.

• Work in partnership with internal teams and external provider offices to obtain necessary documentation.

• Ensure medical records are accurate, complete, legible, and compliant with member information, service dates, and audit standards.

• Arrange files according to established naming conventions and document retention policies.

• Upload records and supporting materials to payer, health plan, and auditor platforms.

• Track project schedules and maintain logs, status reports, and related documentation.

• Address upload errors, rejected files, notifications of missing documentation, and portal-related challenges.

• Keep proof of successful submissions when available.

• Safeguard PHI and PII using secure transmission methods.

• Provide consistent project updates and proactively communicate any delays or issues.

⛳️ Requirements

• Capacity to work collaboratively with internal stakeholders to obtain necessary medical records.

• Ability to communicate effectively and professionally with external healthcare organizations.

• Strong project management capabilities and the ability to meet deadlines.

• Accuracy in verifying member information, service dates, and audit requirements.

• Proven aptitude for resolving issues related to retrieval challenges, provider refusals, incomplete records, and missed deadlines.

• Excellent organizational skills and strict adherence to naming conventions and document retention policies.

• Competence in reviewing medical documentation for accuracy, completeness, and legibility.

• Experience in maintaining tracking logs, status reports, and project documentation.

• Proficiency in uploading medical records to payer, health plan, and auditor platforms.

• Ability to execute member matching, record indexing, and submission quality checks.

• Experience in confirming successful submissions and maintaining upload proof.

• Capability to troubleshoot upload errors, rejected files, notifications of missing documentation, and portal issues.

• Commitment to ensuring the confidentiality and security of PHI and PII.

• Familiarity with HIPAA, HITECH, and relevant federal and state privacy regulations.

• Ability to utilize approved systems, devices, and secure transmission methods.

• Strong communication skills and prompt responsiveness to inquiries.

• Willingness to engage in meetings, training, and ongoing professional development.

• Ability to identify and communicate potential delays or challenges.

🏝️ Benefits

• Medical coverage

• Dental insurance

• Paid time off

• 401(k)

• Competitive pay

• Training, guidance, and support

• Flexible work environment and autonomy

• Ongoing professional development opportunities

• Work-life balance