RADV Medical Records Retrieval Coordinator

Key Responsibilities

• Expand and improve medical records acquisition processes for a risk adjustment (RADV) program
• Perform medical record reviews to ensure documentation meets RADV clinical specifications
• Retrieve medical records to support RADV and internal audit activities
• Cross-functionally coordinate with Compliance, Risk Adjustment, and HIM teams at provider and hospital sites to meet CMS retrieval deadlines
• Maintain HIPAA compliance and ensure secure transmission of all protected health information (PHI)
• Track retrieval progress, maintain reporting dashboards, and proactively escalate risks or delays
• Manage multiple concurrent audit requests and resolve facility-level retrieval issues
• Provide status updates on audits and projects during internal stakeholder meetings
• Prepare PowerPoint presentations for project status reporting

Qualifications

• HS diploma or GED required
• 2-3 years of medical record retrieval experience in a health plan or provider setting (or equivalent administrative experience)
• Strong writing, time management, critical/creative thinking, and communication skills
• Strong working knowledge of Microsoft Office Suite and Outlook
• Strong attention to detail with proven ability to manage high-volume workflows under tight deadlines
• Demonstrated experience coordinating with provider offices and hospital HIM departments
• Prior experience in Managed Care/Health Insurance or a related healthcare field
• Proficiency in multiple EMR systems (Epic, eCW, Athena, Cerner, etc.)
• Understanding of CMS RADV requirements and medical record documentation best practices
• 2-3 years of experience with chart requests/retrievals using risk adjustment modeling
• 2-3 years of experience identifying SOAP notes across specialties using Risk Adjustment, Commercial, and CRG models