Base pay is influenced by several factors including a candidates qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and its why our employees consistently vote us one of the Best Places to Work in PA.
This role is responsible of chart retrieval day to day activities supporting Capitals Medicare Advantage and Commercial Risk Adjustment Program. The Chart Retrieval Specialist is responsible for retrieve, scan, upload medical records at healthcare facilities, process incoming provider correspondence/medical records received through multiple channels, document and storage records/data/correspondence received, perform reconciliation of outstanding medical records, and complete appropriate follow ups to ensure all medical records are received. Additionally, this individual will be working closely with the Risk Adjustment Program Manager, and might work with multiple departments across the organization, provider partners, and business partners (vendors) coordinating and executing chart retrieval efforts ensuring timely completion of the desired chart retrieval Unit results by project and overall Program.
This position requires travel within our 21-county service area (Central PA) & will also include travel to Allentown, Danville, Selinsgrove & Williamsport PA.
- Coordinate appointments with target Healthcare facilities and/or provider offices for on-site chart retrieval activities considering Risk Adjustment projects timelines.
- Scan, upload, and document received medical records using Capitals equipment and process.
- Sort 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.
- Review medical records ensuring a complete medical record is referred to the coding team.
- Reconcile record receipts for provider organizations, distribute outstanding medical records list by provider entity, and complete appropriate follow ups.
- Contact provider offices with a high degree of professionalism and confidence to communicate expectations, details/elements of records required, deadlines, etc.
- Analyze and monitor progress of provider office communications and incoming correspondence to determine which organizations will need additional outreach based on deadlines and agreements.
- ordinate appointments with target Healthcare facilities and/or provider offices for on-site chart retrieval activities considering Risk Adjustment projects timelines.
- Scan, upload, and document received medical records using Capitals equipment and process.
- Sort 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.
- Review medical records ensuring a complete medical record is referred to the coding team.
- Reconcile record receipts for provider organizations, distribute outstanding medical records list by provider entity, and complete appropriate follow ups.
- Contact provider offices with a high degree of professionalism and confidence to communicate expectations, details/elements of records required, deadlines, etc.
- Analyze and monitor progress of provider office communications and incoming correspondence to determine which organizations will need additional outreach based on deadlines and agreements.
- Identify, investigate, escalate for resolution issues related to correspondence, and/or outstanding medical records.
- Maintain up to date daily and weekly production log.
- 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
Skills:
- Strong sense of urgency and due diligence, and discipline.
- Strong influence and persuasion that drive completion of desired actions. Negotiation skills leading to fair agreements for parties involved.
- Excellent verbal communication and interpersonal skills.
- Able to convey contract agreements compliance and regulatory mandates around Risk Adjustment chart retrieval information in a manner that others can understand.
- Proven success on building and maintaining positive relationships. Exemplary of a highly collaborative team approach. Ability to influence and persuade people to collaborate and execute toward a common goal.
- Strong organization and documentation, attention to details, ability to handle multiple project tasks simultaneously, time management meeting deadlines, even under pressure.
- Eager to work with sense of urgency aligned with priorities, overcome obstacles, if needed seek for support early driving the best results to positive impact the Company and team goals.
- Ability to think analytically to resolve issues; solution-focused mindset; creative, innovative, and compliance thinker.
- Adaptability to an agile and dynamic work environment.
- Basic to moderate proficiency level on Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), Project Management tools, Teams/WebEx/ZOOM.
- 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.
Travel Requirements:
- Up to 50% travel time
- This position requires travel within our 21-county service area (Central PA) & will also include travel to Allentown, Danville, Selinsgrove & Williamsport PA.
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 occasionally lift and/or move up to 5 pounds.
Key Interfaces:
- Interfaces with non-executive. Physicians, health system/provider offices staff, CBC staff and management.
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, youll help us live our mission of improving the health and well-being of our members and the communities in which they live.