Medical Retrieval and Risk Adjustment Consultant
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Job Description
Medical records retrieval consultant supporting risk adjustment, HEDIS, and RADV audits for Med Cap Health’s U.S. healthcare network. Coordinating documentation, portal submissions, compliance tracking, and issue resolution.
Responsibilities:
- Coordinate the retrieval, organization, review, and submission of medical records for risk adjustment audits, HEDIS reviews, RADV audits, and related compliance initiatives
- Collaborate with internal stakeholders and external provider offices to secure required documentation
- Verify medical records for accuracy, completeness, legibility, member information, dates of service, and audit requirements
- Organize files according to naming conventions and document retention requirements
- Upload records and supporting documentation to payor, health plan, and auditor portals
- Monitor project timelines and maintain tracking logs, status reports, and project documentation
- Troubleshoot upload errors, rejected files, missing documentation notifications, and portal-related issues
- Maintain proof of successful submissions when available
- Protect PHI and PII and use secure transmission methods
- Provide regular project updates and proactively communicate delays or issues
Requirements:
- Ability to collaborate with internal stakeholders to secure requested medical records
- Ability to communicate professionally with external healthcare facilities
- Strong project management skills and ability to meet deadlines
- Ability to verify member information, dates of service, and audit requirements accurately
- Proven problem-solving skills for retrieval barriers, provider refusals, incomplete records, and missed deadlines
- Strong organizational skills and adherence to naming conventions and document retention requirements
- Ability to review medical documentation for accuracy, completeness, and legibility
- Experience maintaining tracking logs, status reports, and project documentation
- Proficiency uploading medical records to payor, health plan, and auditor portals
- Ability to perform member matching, record indexing, and submission quality checks
- Experience verifying successful submissions and maintaining proof of upload
- Ability to troubleshoot upload errors, rejected files, missing documentation notifications, and portal issues
- Commitment to confidentiality and security of PHI and PII
- Working knowledge of HIPAA, HITECH, and applicable federal and state privacy regulations
- Ability to use approved systems, devices, and secure transmission methods
- Strong communication skills and prompt response to inquiries
- Willingness to participate in meetings, training, and ongoing professional development
- Ability to identify and communicate potential delays or issues
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
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