Duties & Responsibilities:
- Responsible for expanding and improving medical records acquisition for RADV risk adjustment program
- Manages relationships and effectively communicate with internal and external partners regarding quality objectives and targets as they relate to CMS audits.
- Collaborates with key departments on Quality driven initiatives championing process improvement
- Analyzes data to identify data-driven opportunities for improvement and determine root causes in areas that need improvement to be successful in our CMS audits.
- Ensures a working relationship on internal group projects for process improvements.
- Analyzes data to identify trends, issues, and opportunities for performance improvement as it relates to clinical quality
- Prepares quality improvement related presentations that accurately summarize complex information, details and data
- Assists other departments with clinical documentation and coding initiatives
- Provides reporting and summaries on CMS audits in areas, but not limited to, noticeable trends, medical records, and issues.
- Ensures accuracy and completeness of medical records and complying with HIPAA guidelines.
- Analyzes invoice data to reduce billing errors and ensure billable info is correct for the Clinical Documentation and Coding Department audits.
- Additional duties as necessary and as directed
Minimum Qualifications:
- HS Diploma or GED from an accredited institution
- 2-3 years in medical record retrieval in a health plan/ provider setting or administrative experience in lieu of health care setting
- Strong writing, time management, critical/creative thinking, communication, and problem-solving skills.
- Strong working knowledge of Microsoft Office Suite and Outlook
Preferred Qualifications:
- Associates degree or higher from an accredited institution
- Prior experience in Managed Care/Health Insurance, in a health-related field or environment
- Background in health care or managed care. This can include work experience and/or education.
- Experience with a health plan's quality improvement/management department
- Proficiency in multiple EMR systems (Epic, eCW, Athena, Cerner, etc.).
- Understanding of CMS RADV requirements and medical record documentation best practices
Compliance & Regulatory Responsibilities: Ensures all work is compliant with relevant regulatory guidelines.
License/Certification: N/A
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $48,600 - $64,480
All Other Locations (within approved locations): $42,200 - $62,400
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
