Medical Retrieval and Risk Adjustment Consultant

Are you looking for a rewarding opportunity where your attention to detail directly supports regulatory compliance, healthcare quality initiatives, and successful audit outcomes? Med Cap Health is seeking a Medical Records Retrieval & Payor Audit Specialist to join our growing team in a full-time, Monday-Friday 8:00 AM-5:00 PM schedule as a 1099 employee. If you're someone who loves staying organized, meeting deadlines, and playing a vital role behind the scenes, we want to hear from you. Apply today and bring your expertise to a remote team that values precision, accountability, and success.

Here, you'll have the opportunity to work independently while receiving the training, guidance, and support necessary to excel. You'll collaborate with experienced healthcare professionals, contribute to meaningful compliance initiatives, and help support quality patient care outcomes across our growing organization. We offer competitive pay, medical coverage, dental insurance, paid time off, 401(k), and more, all while fostering a culture centered around flexibility, respect, collaboration, and work-life balance. If you're ready to join an organization that recognizes the impact of your work, we encourage you to apply today.

WHAT SETS US APART

We believe in delivering high-quality, in-house medical care that leads to exceptional patient outcomes. Our mission is to provide comprehensive, long-term care in a compassionate and collaborative environment, and with over 70 providers across the state, our network continues to grow, supporting more patients each year.

Our team is committed to providing a flexible and supportive work environment. We offer autonomy, allowing you to manage your time while providing the oversight and training you need to succeed. With facilities located across the nation, our employees appreciate the work-life balance we promote and the understanding we show when life's unexpected moments arise.

WHAT WE'RE LOOKING FOR IN A MEDICAL RETRIEVAL AND RISK ADJUSTMENT CONSULTANT

• Ability to collaborate effectively with internal stakeholders to secure access to requested medical records
• Ability to communicate professionally with external healthcare facilities to obtain records when documentation is not available internally
• Strong project management skills with the ability to track and manage retrieval activities while meeting established deadlines
• Ability to accurately verify member information, dates of service, and audit requirements
• Proven problem-solving skills with the ability to identify and escalate retrieval barriers, including provider refusals, incomplete records, and missed deadlines
• Strong organizational skills with the ability to maintain records in accordance with company naming conventions and document retention requirements
• Ability to review medical documentation for accuracy, completeness, and legibility prior to submission
• Detail-oriented approach to identifying duplicate, incomplete, or irrelevant documentation and communicating deficiencies appropriately
• Experience maintaining accurate tracking logs, status reports, and project documentation
• Proficiency uploading medical records and supporting documentation to payor, health plan, and auditor portals
• Ability to ensure accurate member matching, record indexing, and submission quality
• Experience verifying successful submissions and maintaining proof of upload when available
• Ability to troubleshoot and resolve upload errors, rejected files, missing documentation notifications, and portal-related issues
• Demonstrated commitment to maintaining the confidentiality and security of Protected Health Information (PHI) and Personally Identifiable Information (PII)
• Working knowledge of HIPAA, HITECH, and applicable federal and state privacy regulations
• Ability to utilize approved systems, devices, and secure transmission methods when handling sensitive information
• Strong communication skills with the ability to provide regular project updates and respond promptly to inquiries
• Willingness to participate in meetings, training sessions, and ongoing professional development opportunities
• Ability to proactively identify and communicate potential delays or issues that may affect project timelines and completion

YOUR NEW ROLE AS OUR MEDICAL RETRIEVAL AND RISK ADJUSTMENT CONSULTANT

In this rewarding role, you'll spend your day coordinating the retrieval, organization, review, and submission of medical records in support of risk adjustment audits, HEDIS reviews, RADV audits, and related compliance initiatives. You'll partner with internal stakeholders and external provider offices to secure required documentation, carefully verify records for accuracy and completeness, organize files according to established standards, and ensure timely uploads to designated payor and auditor portals. Along the way, you'll monitor project timelines, maintain detailed tracking documentation, troubleshoot submission issues, protect sensitive information, and provide ongoing status updates that help keep critical healthcare compliance projects moving forward. Your ability to stay organized, maintain accuracy, and proactively address challenges will play a direct role in the success of audit and compliance efforts across the organization.

If you're looking for an opportunity where your organization, accuracy, and problem-solving abilities can make a meaningful impact, we'd love to connect with you. Apply today with ur initial application!