Manager, Risk Adjustment Medical Record Retrieval

Bright Health Group

Remote
  • Job Type: Full-Time
  • Function: Life Sciences R&D/Engineering
  • Industry: Health Care
  • Post Date: 01/25/2023
  • Website: brighthealthgroup.com
  • Company Address: 8000 Norman Center Dr, Suite 1200, Bloomington, Minnesota 55437, US
  • Salary Range: $50,000 - $150,000

About Bright Health Group

Bright Health Group delivers a smarter, more connected healthcare experience. The company’s exclusive partnerships with leading health systems, affordable health insurance plans, and simple, friendly approach to technology are reshaping how people and physicians achieve better health together.

Job Description

Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.


 

ROLE RESPONSIBILITIES

The Manager of Medical Records Retrieval description is intended to point out major responsibilities within the role, but it is not limited to these items.

  • Manage end-to-end medical record retrieval processes to support key operational projects/programs within the Risk Adjustment and STARS/Quality department, including but not limited to HEDIS, RADV, quality of care concerns, and supplemental data audits. In addition, working collaboratively with provider relations and the in-market clinical team to develop and manage a coordinated outreach between Risk Adjustment, Quality, and Stars
  • Develop and maintain internal medical records repository and storage solutions to ensure accurate and timely record uploads, compliance with processes to protect PHI, and effective tracking of records and record requests
  • Provide consistent communications to all levels of the organization regarding the status, successes, and risks of any medical record retrieval project
  • Identify process issues and contribute to the design of solutions while proactively implementing process improvements, as well as developing and maintaining all applicable policies and procedures
  • Subject Matter Expert in all aspects of health information management, including HIPPA compliance for medical records
  • Maintain staffing and scheduling plans to meet departmental objectives as provided by leadership, including meeting specified service levels
  • Hire and train new team members, in addition to monitoring and guiding team efforts through coaching and career development activities

SUPERVISORY RESPONSIBILITIES

  • This position has supervisory responsibilities for medical records team members.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor’s degree in business or healthcare-related field OR relevant experience instead of a degree
  • Experience working in a HEDIS/Quality and/or risk adjustment department is a huge plus
  • Advanced certification in coding or health information management, such as RHIA, RHIT, CPC, CCS, etc. a plus
  • Two (2) or more years of medical record management experience, ideally in a managed care organization, risk adjustment and/or HEDIS vendor, and/or health plan including exposure to varying types of paper and/or electronic medical records, required
  • Two (2) or more years of experience with vendor oversight and management, including invoicing required
  • Two (2) or more years of project management experience preferred
  • Prefer experience with process development, management, and improvement
  • One to two years of team management/supervisory experience preferred, including leading and managing cross-functional teams
  • Ability to travel may be required

PROFESSIONAL COMPETENCIES

  • Requires exceptional customer service skills (in person and telephonic)
  • Requires proficiency in Microsoft products, Excel, Access, Word, and PowerPoint

WORK ENVIRONMENT

  • The majority of work responsibilities are performed remotely or in an open office setting (if preferred/location dependent), carrying out detailed work sitting at a desk/table and working on the computer.
  • Travel may be required.

 

 

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.

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