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The Role
The Senior Specialist, RADV Retrieval is responsible for executing the day-to-day medical record retrieval operations supporting internal risk adjustment (RA) audits, CMS-RADV, HHS-RADV, and other regulatory audit activities. This role focuses on obtaining complete medical records for internal and external Medicare Advantage (MA) and Affordable Care Act (ACA) audit samples to ensure high-yield, compliant, and timely acquisition within strict regulatory windows.
Working collaboratively with the Lead Specialist, the Senior Specialist conducts direct outreach to provider offices, Health Information Management (HIM) departments, and contract retrieval vendors to resolve operational barriers, track chart progress, and maintain audit defensibility.
Key Responsibilities
Core Retrieval Execution & Provider Outreach
Execute end-to-end medical record retrieval activities across internal audit, MA CMS-RADV, and ACA HHS-RADV audit samples, managing competing deadlines across overlapping audit cycles.
Conduct direct provider, clinic, and HIM department outreach to request records, clarify documentation needs, and resolve retrieval bottlenecks.
Manage outreach cadence and professional communication to minimize provider abrasion and preserve positive provider network relationships.
Maintain detailed, time-stamped documentation of all outreach attempts, contact methods, escalations, and receipt confirmations to ensure full audit defensibility.
Vendor & Workflow Coordination
Coordinate daily medical record retrieval workflows with external retrieval and coding vendors to track sample completion against established targets.
Perform primary source verification on retrieved records to ensure completeness, legibility, and compliance prior to coding handoff.
Partner with internal coding, quality assurance, and data analytics colleagues to route retrieved charts and prioritize urgent, high-risk, or time-sensitive samples.
Escalate persistent provider non-response, system barriers, or timeline risks promptly to the Lead Specialist and Senior Manager.
Compliance & Process Support
Ensure all chart acquisition and data transfer activities strictly adhere to HIPAA, HITECH, CMS, HHS, and organizational secure PHI transmission protocols.
Maintain accurate, real-time tracking of assigned audit sample retrieval status, yields, and turnaround times in tracking systems.
Participate in recurring quality checks to ensure retrieved documentation meets regulatory audit submission standards.
Support special projects and process improvement initiatives within the RADV Compliance Center of Excellence.
Qualifications
Education
High school diploma or GED required OR a minimum of three (3) years of relevant healthcare/HIM experience in lieu of a degree.
Experience & Skills
Minimum two (2) to four (4) years of experience in medical record retrieval, provider outreach, health information management (HIM), or risk adjustment operations.
Working knowledge of MA and ACA risk adjustment models, CMS-RADV / HHS-RADV audit timelines, and medical documentation standards.
Demonstrated experience coordinating retrieval workflows across multiple providers, clinics, and third-party vendors simultaneously.
Working knowledge of HIPAA, HITECH, and secure electronic PHI transmission protocols.
Strong organizational and time-management skills with proven ability to handle high-volume, deadline-sensitive caseloads.
Effective interpersonal, verbal, and written communication skills.
Preferred Qualifications
Associate degree in Health Information Technology, Healthcare Administration, or related field.
Certified Medical Records Technician (CMRT), Registered Health Information Technician (RHIT), or equivalent HIM credential.
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location
Hingham Time Type
Full time
Hourly Range: $31.91 - $37.06
The job posting range…