Risk Adjustment Coordinator II
Posted on: 19 Jan 2021
Tampa, FL
Job Description
Position Purpose:
Provides lead process expertise for the development, tracking and monitoring of RAPS medical records requests and the request and retrieval cycle. Acts as a subject matter expert with regards to the chart request/retrieval process and interfaces with vendors, the RAC coordinator, management and market leadership on the efficacy of chart retrieval and inventory goals.
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* Manages the RAPS chart chase database and distributes work or work assignments to meet productivity demands. Chiefly responsible for the administrative management of the RAPS chart chase database.
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* Coordinates with the vendors the current volume expectations, statuses of requests, timeliness and completeness of chart chase request and retrieval.
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* Monitors inventory and production metrics and reports to the Manager the timeliness of the chart requests, the inventory and load balancing of requests, and the efficiency of chart retrieval.
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* Meets and communicates routinely with Market leadership, market reps, department leadership and vendor management to update, assess and coordinate chart retrieval.
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* Partners with Market leadership and market reps on the efficacy of the chart chase, the areas of opportunity and the need/urgency for record retrieval.
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* Perform other duties as assigned.
Education/Experience:
High school diploma or equivalent. 2+ years of customer service or medical office experience. Experience with medical record retrieval systems preferred. Managed care risk adjustment experience preferred. Intermediate Excel skills preferred. Critical thinking skills needed.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
