BusinessOperations - Member Risk Adjustment Coordinator I - 210929

Mindlance

🇺🇸 United States
Remote
Manager or above
3 days ago

Excel
CMS

3 days ago

Not enough detail in this posting to match

Position Purpose: Schedule appointments, gather medical histories and updated member and provider information in support of member outreach and claims reimbursement.

Education/Experience: High school diploma or equivalent. 0-2+ years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Beginner level Excel skills.

Assist members with scheduling office visits with primary care provider.
Retrieves charts from electronic medical record systems and compile medical records to send to other parties for coding.
Requests medical records by making outbound phone calls to provider groups.
Completes supplemental medical records requests using Excel files.
Assist with providing updated member and provider information to vendors.
Directs medical record requests to the responsible party.
Resolves outstanding vendor pends within a timely manner by updating member and provider demographics and working with chart load issues.
Ensure follow up on member appointments or other tasks designated.
Assist with ad hoc requests.

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”

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Position Purpose: Schedule appointments, gather medical histories and updated member and provider information in support of member outreach and claims reimbursement. Education/Experience: High school diploma or equivalent. 0-2+ years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Beginner level Excel skills. Assist members with scheduling office visits with primary care provider. Retrieves charts from electronic medical record systems and compile medical records to send to other parties for coding. Requests medical records by making outbound phone calls to provider groups. Completes supplemental medical records requests using Excel files. Assist with providing updated member and provider information to vendors. Directs medical record requests to the responsible party. Resolves outstanding vendor pends within a timely manner by updating member and provider demographics and working with chart load issues. Ensure follow up on member appointments or other tasks designated. Assist with ad hoc requests.
Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?	Oversight of RADV audits. Team collaborates to ensure tasks are completed and assist with escalations and training. Ensure audit activities are completed according to established timelines and operational deadlines. Support retrieval efforts to achieve target retrieval rates (RADV goals reference maintaining 98–100% overall retrieval performance across contracts. Complete assigned deliverables on or before required deadlines and support rapid issue resolution. Maintain accurate audit tracking, reporting, documentation, and validation activities. Follow CMS, HHS, and internal audit requirements while ensuring documented processes are consistently applied. Provide timely updates to health plans, vendors, leadership, and cross-functional partners. Escalate risks early. Collaborate effectively with vendors, health plans, Compliance, and Operations teams
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?	Associates will be responsible for retrieving charts, working escalations, and running calls to discuss audit chart retrieval status Should have some excel knowledge and be detailed oriented.
Candidate Requirements
Education/Certification	Required: High school diploma or equivalent.	Preferred:
Licensure	Required:	Preferred:
Years of experience required: . 0-2+ years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Disqualifiers: Additional qualities to look for:
Top 3 must-have hard skills stack-ranked by importance	1	Maintain accurate, complete, and audit-ready documentation
2	Attention to Detail / Problem Solve
3	Cross-Functional Communication & Relationship Management
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations	Projected Manager Candidate Review Date:	1-2 days post shortlisting
Type of Interviews:	Teams, phone, etc.
Required Testing or Assessment (by Vendor):	n/a
Next Steps
Do you have any upcoming PTO?	10/9 – 10/11
Colleagues to cc/delegate	Hazne Eguino
Compliance Questions
(Department of Defense) Will this role operate, support, or utilize DOD data, systems, and/or infrastructure, requiring a National Agency Check with Law and Credit Checks (NACLC)? (Vendors: If yes, NACLC check is required).	No

BusinessOperations - Member Risk Adjustment Coordinator I - 210929 · Mindlance

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