The Risk Adjustment Administration Representative 4 responsible for obtaining accurate healthcare information from providers to ensure appropriate clinical care for members and maintain accurate payment levels. The Risk Adjustment Administration Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.
The Risk Adjustment Administration Representative 4 may conduct analysis of data, provider or member outreach, and/or record retrieval. For Risk Adjustment Coding, please use that job family. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards retrieval scheduling, weekly/ yearly goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight.
3+ years of experience working as a medical records retrieval specialist, in a provider office or healthcare administration, or copy service company
Proficiency in all Microsoft Office applications, including Word and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Valid Drivers License and reliable transportation
We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.
If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
Strong written and verbal communication skills; strong analytical, organizational and time management skills
Knowledge and experience in health care environment/managed care
Strong knowledge of ICD-9/10 codes
Scheduled Weekly Hours
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