Base pay is influenced by several factors including a candidate’s 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 it’s 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 Capital’s 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.

• 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 Capital’s 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.
• 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.
• Special projects as assigned
• Coordinate appointments with target Healthcare facilities and/or provider offices for on-site chart retrieval activities considering Risk Adjustment projects timelines.

Skills:

• Excellent verbal communication and interpersonal skills.
• Basic to moderate proficiency level on Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), Project Management tools, Teams/WebEx/ZOOM.
• 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.
• 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.
• Ability to think analytically to resolve issues; solution-focused mindset; creative, innovative, and compliance thinker.
• Adaptability to an agile and dynamic work environment.
• 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.
• Excellent verbal communication and interpersonal skills.
• Basic to moderate proficiency level on Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), Project Management tools, Teams/WebEx/ZOOM.

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:

• 1 year experience in an Operations Environment
• Proven experience communicating directly with providers or provider offices,
• 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)

Location: 

• This position is classified hybrid, which requires occasional travel in the Allentown and surrounding areas. 

Work Environment:

• Must have reliable transportation 
• 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.

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 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.