[Hiring] Utilization Management Medical Records Coordinator @CareSource

Role Description

The Utilization Management Medical Records Coordinator is responsible for all forms and aspects of medical record retrieval, including, but not limited to:

• Claims data analysis
• Outreach data research
• Request of Information (ROI) deployment
• Pend-record resolution
• Medical record audits
• Attestation capture
• Report documentation

In addition, the Utilization Management Medical Records Coordinator serves as a knowledge resource for the team, leveraging their knowledge to:

• Address issue escalations
• Research process enhancements
• Resolve complex/problematic medical record retrieval issues

Essential Functions include:

• Coordinate and execute the request, retrieval, and pend resolution of medical records through various channels
• Provide personal information necessary to gain access to health network systems when needed
• Collaborate with health systems and provider offices to execute and document their process for release of information requests
• Enhance and update operational databases, and provide context by documenting commentary
• Initiate, support, and implement process improvements with all external and internal partners
• Utilize the office suite including, but not limited to MS Teams, Office, Excel, Outlook, and Word to facilitate record retrieval and execute mail merge
• Verify retrieved medical records’ accuracy
• Manage portal, and FTP-based data transfers to facilitate medical record retrieval
• Manage practice and health network relations to minimize provider abrasion
• Generate 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
• Review, research, and correct claims data to produce information optimized for chart retrieval
• Review and reconcile retrieval related invoices
• Meet production and quality standards for medical record processing cycle
• Support special projects
• Assist with team’s training and development
• Serve as knowledge resource for team
• Perform any other job related duties as requested

Qualifications

• High School or GED diploma required
• Eighteen (18) months of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) required
• Managed Care experience preferred

Requirements

• 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 orientation
• 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

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time
• May be required to work additional hours and/or outside normal business hours as needed to meet deadlines
• Travel is not typically required

Compensation Range

$41,200.00 - $66,000.00

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

Organization Level 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.