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BusinessOperations - Member Risk Adjustment Coordinator I - 210929

Role overview

Qualifications

  • High school diploma or equivalent
  • 0-2+ years of customer service or medical office experience
  • Experience with preserved medical record retrieval systems preferred
  • Billing or coding experience preferred

Responsibilities

  • Assist members with scheduling office visits with primary care provider
  • Retrieves charts from electronic medical record systems and compile medical records to send to other parties for coding
  • Requests medical records by making outbound phone calls to provider groups
  • Resolves outstanding vendor pends within a timely manner by updating member and provider demographics and working with chart load issues

Key facts

Hard skills

Other skills

  • Detail Oriented
  • Lateral Communication
  • Customer Service
  • Microsoft Excel
  • Problem Solving

About the company

Mindlance logo

Mindlance

Staffing & Recruiting

Founded in 1999, Mindlance is one of the largest diversity-owned staffing firms in the US and has been on SIA’s list of Fastest Growing US Staffing Firms for 10 years. Mindlance has also been recognized as one of the consistently best performing partners to industry-leading MSP programs including Allegis, Kelly, TAPFIN, PROUnlimited, Pontoon, GRI, WorkforceLogiq and Agile-1.What started with contingent staffing has developed to a comprehensive portfolio of workforce solutions. Along with industry specific, talent-centric staffing across a range of specializations- Technology, Engineering, Scientific, Clinical Research, Digital, Creative, Marketing, Profession, Mindlance provides Managed Recruitment services- RPO and Direct + Diverse Sourcing, and Pay+ Services- EoR/Payroll, IC Compliance and AoR.Mindlance is also generating alternative talent pipelines that prioritize diversity through three Diverse Talent Acceleration offerings: (1) RebootTalent, a diverse returning talent acceleration service (2) Mindlance Diversphere, a private diverse talent pool aggregated from a network of diversity partnerships and (3) Quintrix Solutions, an upskilling recruit-train-deploy service.With a year-over-year growth rate of 20% and an annual revenue of over $400 million and growing, the Mindlance story is one of calculable achievement, made meaningful by the commitment to grow a mindful way that creates balance in the work and societal ecosystem.Visit www.mindlance.com to learn more about us and our latest job openings.STAFFING INDUSTRY ANALYSTS RECOGNITIONS:Fastest Growing U.S. Staffing Firms (2022, 2021, 2019, 2018, 2017, 2016, 2015, 2014, 2013, 2012, 2011)Largest U.S. Staffing Firms (2022, 2021, 2020, 2019, 2018, 2017, 2016, 2015)Largest Diversity-Owned U.S. Staffing Firms (2022, 2021, 2020, 2019, 2018, 2017, 2016, 2015)Largest IT Staffing Firms (2022, 2021, 2020, 2019, 2018, 2017)Largest Clinical & Scientific Staffing Firms (2022, 2021, 2020, 2019, 2018, 2017)

Company details

Company typeLarge
IndustryStaffing & Recruiting
Company size1001 - 5000

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Job description

Position Purpose: Schedule appointments, gather medical histories and updated member and provider information in support of member outreach and claims reimbursement.

Education/Experience: High school diploma or equivalent. 0-2+ years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Beginner level Excel skills.

Assist members with scheduling office visits with primary care provider.
Retrieves charts from electronic medical record systems and compile medical records to send to other parties for coding.
Requests medical records by making outbound phone calls to provider groups.
Completes supplemental medical records requests using Excel files.
Assist with providing updated member and provider information to vendors.
Directs medical record requests to the responsible party.
Resolves outstanding vendor pends within a timely manner by updating member and provider demographics and working with chart load issues.
Ensure follow up on member appointments or other tasks designated.
Assist with ad hoc requests.

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”

============================
Position Purpose: Schedule appointments, gather medical histories and updated member and provider information in support of member outreach and claims reimbursement.

Education/Experience: High school diploma or equivalent. 0-2+ years of customer service or medical office experience. Experience with preserved medical record retrieval systems preferred. Billing or coding experience preferred. Beginner level Excel skills.

Assist members with scheduling office visits with primary care provider.
Retrieves charts from electronic medical record systems and compile medical records to send to other parties for coding.
Requests medical records by making outbound phone calls to provider groups.
Completes supplemental medical records requests using Excel files.
Assist with providing updated member and provider information to vendors.
Directs medical record requests to the responsible party.
Resolves outstanding vendor pends within a timely manner by updating member and provider demographics and working with chart load issues.
Ensure follow up on member appointments or other tasks designated.
Assist with ad hoc requests.
Story Behind the Need
  • What is the purpose of this team?
  • What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
  • Describe the surrounding team (team culture, work environment, etc.) & key projects.
  • Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
Oversight of RADV audits. Team collaborates to ensure tasks are completed and assist with escalations and training. Ensure audit activities are completed according to established timelines and operational deadlines. Support retrieval efforts to achieve target retrieval rates (RADV goals reference maintaining 98–100% overall retrieval performance across contracts. Complete assigned deliverables on or before required deadlines and support rapid issue resolution. Maintain accurate audit tracking, reporting, documentation, and validation activities. Follow CMS, HHS, and internal audit requirements while ensuring documented processes are consistently applied. Provide timely updates to health plans, vendors, leadership, and cross-functional partners. Escalate risks early. Collaborate effectively with vendors, health plans, Compliance, and Operations teams






Typical Day in the Role
  • Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
  • What are performance expectations/metrics?
  • What makes this role unique?
Associates will be responsible for retrieving charts, working escalations, and running calls to discuss audit chart retrieval status Should have some excel knowledge and be detailed oriented. Candidate Requirements Education/Certification Required: High school diploma or equivalent.
Preferred: Licensure Required: Preferred: Years of experience required: . 0-2+ years of customer service or medical office experience. Experience with
preserved medical record retrieval systems preferred.

Disqualifiers:

Additional qualities to look for:
  • Top 3 must-have hard skills stack-ranked by importance
1 Maintain accurate, complete, and audit-ready documentation
2 Attention to Detail / Problem Solve
3 Cross-Functional Communication & Relationship Management
Candidate Review & Selection
  • Shortlisting process
  • Candidate review & selection
  • Interview information
  • Onboard process and expectations
Projected Manager Candidate Review Date: 1-2 days post shortlisting
Type of Interviews:
Teams, phone, etc. Required Testing or Assessment (by Vendor): n/a Next Steps
  • Do you have any upcoming PTO?
10/9 – 10/11
  • Colleagues to cc/delegate
Hazne Eguino Compliance Questions
  • (Department of Defense) Will this role operate, support, or utilize DOD data, systems, and/or infrastructure, requiring a National Agency Check with Law and Credit Checks (NACLC)? (Vendors: If yes, NACLC check is required).
No

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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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