Medical Records Coordinator II

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care.

Job Summary:

The Medical Records Coordinator II is responsible for all forms and aspects of retrospective medical record retrieval including, but not limited to, claims data analysis, outreach data research, direct EMR retrieval, Requests of Information (ROI) deployment, pend-record resolution, medical record audits, attestation capture, and report documentation.

Essential Functions:

• Execute the request, retrieval, and pend resolution of medical records through various channels
• Utilize custom and SFTP portals to facilitate PHI data transfer
• When needed provide personal information necessary to gain access to health network systems
• Collaborate with health systems and provider offices to execute, and document their process for release of information requests
• Update operational databases, and provide context by documenting commentary
• Navigate and properly escalate obstacles to medical record retrieval
• Support and implement process improvements with external and internal partners
• Utilize the MS Office Suite including, but not limited to MS Teams, Office, Excel, Outlook, and Word to facilitate record retrieval and execute mail merges
• Verify retrieved medical records’ accuracy
• Partner across CareSource’s department matrix to address operational needs
• Support and maintain medical record repository
• Manage provider practice and health network relations to minimize provider abrasion
• Populate chase specific reports to drive and reflect the execution of risk adjustment programs
• Support and refine implementation of risk adjustment processes across all lines of business
• Research claims data to produce information optimized for chart retrieval
• Reconcile retrieval related invoices
• Perform any other job duties as requested

Education and Experience:

• High School Diploma or equivalent required
• Minimum one (1) year healthcare experience required
• Minimum one (1) year medical records experience required
• Minimum one (1) year EHR/EMR experience required

Competencies, Knowledge and Skills:

• Intermediate proficiency in the Microsoft Office Suite
• Verbal and written communication skills
• Ability to work independently and within a team environment
• Attention to detail
• Critical listening and thinking skills
• Time management skills
• Proper phone etiquette
• Data analysis
• Business analysis
• Project management
• Customer service oriented
• Brand ambassadorship
• Decision making/problem solving skills
• Takes initiative to research and resolve obstacles
• Must be able to self-direct work when given a goal/task

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• May be required to travel

Compensation Range:
$35,900.00 - $57,300.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Hourly

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.