Risk adjustment coordinator, chart retrieval

Job Details:

Job Location: Huntington Beach Office - Huntington Beach, CA

Position Type: Full Time

Salary Range: $22.69 - $26.44 Hourly

This position operates on a hybrid work schedule. This position will require 3 days onsite at the Huntington Beach office.

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We?

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

Why Join Us?

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Job Summary

The Risk Adjustment Coordinator, Chart Retrieval is responsible for obtaining complete and legible medical records from primary care provider (PCP) offices, medical groups, IPAs, hospitals, and other contracted providers to support Clever Care Health Plan’s Medicare Advantage Risk Adjustment program. This position addresses a critical operational need by improving the timeliness and success rate of medical record retrieval needed to validate submitted HCCs, complete Level 2 coding review, conduct retrospective sweeps, and defend CMS Risk Adjustment Data Validation (RADV) samples.

Functions & Responsibilities

• Medical Record Retrieval Operations: Manage assigned chart retrieval requests from initiation through receipt, validation, routing, and closure.
• Record Completeness & Intake Validation: Confirm that retrieved records match the correct member, provider, date of service, and requested encounter or audit period before routing for review.
• Provider Outreach & Relationship Management: Build productive working relationships with PCP office managers, medical records staff, health information management departments, and IPA contacts.
• RADV & Audit Support: Execute retrieval assignments for CMS RADV, internal audits, coding validation, and other regulatory or compliance reviews within prescribed turnaround times.
• Retrospective & Coding Validation Support: Support retrospective chart review sweeps by securing medical records for targeted members, providers, and dates of service.
• Tracking, Reporting & Performance Improvement: Maintain accurate, real-time status in chart retrieval logs, workflow platforms, and dashboards.
• Vendor & Cross-Functional Coordination: Coordinate retrieval assignments with external vendors to prevent duplicate requests, clarify ownership, and ensure complete status visibility.

Qualifications:

Education and Experience: High school diploma or equivalent required; associate or bachelor’s degree in Health Information Management, Healthcare Administration, Business Administration, or a related field preferred. Minimum two (2) years of experience in medical record retrieval, health information management, provider office operations, risk adjustment, coding support, claims, or managed care operations.

Skills & Competencies: Strong telephone, written communication, relationship-management, and follow-up skills. Demonstrated persistence and professionalism in resolving provider office barriers and obtaining time-sensitive records.

Wage Range:

$22.69/hour - $26.44/hour

Physical & Working Environment:

Must be able to travel when needed or required, including occasional travel to provider offices for medical record retrieval.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

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