Chart Retrieval Specialist - Field

Position Description: The Capital BlueCross Chart Retrieval Specialist position will: Promptly and accurately process incoming provider correspondence and medical records related to Risk Adjustment Team activities through multiple channels (i.e., phone, web, electronic, and/or face-to-face) by using resources, materials and tools with accuracy and precision. Perform reconciliation on provider organizations to ensure all medical records are accounted for as appropriate; communicating with provider offices as needed. Review claims data to determine if follow-up is needed. Provide training to temporary staff as needed. Responsibilities and Qualifications:

Duties and Responsibilities:

• 95% - Retrieval of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate and a 95% efficiency rate. Must support continued development of the CBC Government Risk Adjustment and Stars programs. Perform processing tasks such as: sorting incoming mail, preparing documents for scanning, retrieving fax information, moving and storing documents as appropriate, copying data, posting data in logs, compiling records, and routing / distributing documents following specific procedures. Reconcile record receipts to organizations; reviewing claims to determine which medical records should be pursued. Generate panel lists to send to provider offices. Contact provider offices with a high degree of professionalism and confidence to communicate expectations, details of records required, etc. Analyze and monitor progress of provider office communication and incoming correspondence to determine which organizations will need additional outreach. Identify, investigate and resolve issues related to incoming correspondence. Review records and transactions for accuracy. Investigate and resolve discrepancies. Maintain, update and purge files. Provide a high level of service to both external and internal customers. Use computer systems and applications for data entry, edits, and information retrieval. Operate office equipment including calculators, computers, faxes, copiers, scanners, micrographic filming and fiche retrieval, and handle routine up-keep tasks. Exhibit a spirit of teamwork. Contribute ideas for unit success. Special projects as assigned.
• 5% - Offer suggestions and assistance for improvement in departmental processes & other duties as assigned.

Skills:

• Excellent written and oral communication skills.
• Ability to use various computer applications for data entry
• Demonstrated ability to consistently produce high quality work products in a timely and appropriate manner
• Strong degree of organization, ability to handle large scale chart requests and juggle multiple outbound calls
• Provide training to temporary staff when necessary, clearly communicating project objectives, goals and processes.
• Detail oriented with high degree of accuracy.
• Ability to exercise discretion in handling confidential member information.
• Strong commitment to customer service and understanding and responding to customer needs within specific timeframes.
• Maintains established work production standards
• Ability to work independently in a time-oriented environment

Knowledge:

• Knowledge of Medicare ACA Risk Adjustment and Government programs.
• Knowledge of personal computer operations and software packages
• Knowledge of claims systems or equivalent professional experience
• Knowledge of risk adjustment principles and coding updates a plus

Experience:

• Proven experience communicating directly with providers or provider offices
• 1-3 years’ experience in an Operations Environment
• Experience with handling or processing medical records preferred.
• Skilled with MS Office, and data entry into MS Access and MS Excel
• Prior CMS/HHS risk adjustment experience a plus

Education and Certifications:

• High school diploma or equivalent (GED)

Work Environment:

Ability to operate a personal computer (PC), including proficiency in Microsoft Office Suite. Demonstrated ability to interact with other departments. Demonstrates openness, flexibility, problem solving, patience, and tact when dealing with providers, members and staff.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must be able to work over 40 hours per week. The employee must occasionally lift and/or move up to 5 pounds.

About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.