Risk Adjustment Coordinator, Chart Retrieval at Clever Care Health Plan

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.

The Coordinator manages the end-to-end chart retrieval workflow, including request preparation, provider outreach, follow-up, escalation, receipt validation, secure record handling, and status tracking. The role works closely with Risk Adjustment Coding, Compliance, Vendors, Analytics, hospitals, and provider office staff to ensure records are retrieved within required timeframes and are routed promptly for coding validation and audit review.

The position is expected to increase internal retrieval capacity, reduce vendor-only dependency, improve provider responsiveness, and minimize missed coding validation and audit-defense opportunities caused by unavailable or incomplete medical records.

Functions & Responsibilities

Medical Record Retrieval Operations

• Manage assigned chart retrieval requests from initiation through receipt, validation, routing, and closure.
• Contact PCP offices, IPAs, medical groups, hospitals, specialists, and other record custodians by telephone, fax, secure email, provider portal, or approved electronic exchange methods.
• Obtain records needed to validate HCCs submitted on encounters and claims, complete Level 2 coding review, support retrospective sweeps, and respond to RADV sample requests.
• Perform persistent and professional follow-up using established contact cadence, due dates, and escalation pathways.
• Coordinate on-site retrieval or secure remote access when standard outreach methods are unsuccessful or when record volume requires an alternative approach.
• Prioritize requests based on regulatory deadlines, audit exposure, coding review timelines, financial impact, submission cutoffs, and leadership direction.

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.
• Validate that records are complete, legible, signed or authenticated as applicable, and include all requested pages and supporting documentation.
• Identify missing pages, incorrect dates of service, duplicate files, illegible images, incomplete progress notes, or records for the wrong member and promptly re-request corrected documentation.
• Index, label, upload, and route records accurately within approved systems and workflows to support timely coder access and Level 2 review.
• Maintain HIPAA-compliant handling of protected health information and follow minimum necessary, secure transmission, and retention requirements.

Provider Outreach & Relationship Management

• Build productive working relationships with PCP office managers, medical records staff, health information management departments, and IPA contacts.
• Explain the purpose, urgency, and documentation requirements of chart requests in clear, provider-friendly language.
• Research alternate provider contacts, medical record vendors, portal access, and office workflows when established contacts are unresponsive or inaccurate.
• Partner with Provider Relations to resolve recurring access barriers, outdated contact information, refusal to release records, contractual issues, or persistent nonresponse.
• Provide feedback on provider retrieval performance and recommend targeted education or escalation for offices with repeated delays.

RADV & Audit Support

• Execute retrieval assignments for CMS RADV, internal audits, coding validation, and other regulatory or compliance reviews within prescribed turnaround times.
• Maintain clear documentation of each request, outreach attempt, response, barrier, escalation, and final disposition to support a defensible audit trail.
• Immediately escalate missing, unavailable, or incomplete records that may affect audit defense or regulatory deadlines.
• Coordinate with Risk Adjustment leadership, coding auditors, Compliance, and external audit support partners to resolve record discrepancies and outstanding sample items.

Retrospective & Coding Validation Support

• Support retrospective chart review sweeps by securing medical records for targeted members, providers, and dates of service.
• Coordinate with coding teams to clarify record needs and obtain supplemental documentation or missing portions required to complete coding review.
• Monitor requests connected to submitted HCC validation and ensure results are available before applicable review and submission deadlines.
• Help reduce missed coding validation opportunities by identifying retrieval risks early and maintaining active follow-up until closure or formal escalation.

Tracking, Reporting & Performance Improvement

• Maintain accurate, real-time status in chart retrieval logs, workflow platforms, and dashboards, including request date, aging, outreach attempts, receipt date, completeness, escalation, and closure reason.
• Monitor retrieval rates, turnaround time, aging, first-request success, no-response rates, incomplete-record rates, and performance by provider, IPA, request type, and retrieval channel.
• Prepare routine status reports and work queues for leadership, coding, provider relations, and audit stakeholders.
• Identify trends and root causes that affect retrieval success and recommend workflow, contact data, technology, or provider engagement improvements.
• Compare internal and vendor retrieval outcomes and support strategies that reduce vendor-only dependency while maintaining scalable capacity.
• Meet established productivity, quality, accuracy, and retrieval-rate expectations.

Vendor & Cross-Functional Coordination

• Coordinate retrieval assignments with external vendors to prevent duplicate requests, clarify ownership, and ensure complete status visibility.
• Reconcile vendor status reports and validate that received records are accessible, complete, and routed appropriately.
• Partner with Coding, Provider Relations, Compliance, Analytics, IT, and Operations to resolve barriers and improve the end-to-end retrieval process.
• Participate in process improvement initiatives, system testing, procedure development, and special projects related to chart retrieval and risk adjustment operations.

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.
• Experience communicating directly with PCP offices, medical groups, IPAs, hospitals, or medical record departments.
• Medicare Advantage or health plan experience preferred.
• Experience supporting retrospective chart review, coding validation, HCC review, or RADV activities preferred.

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.
• Ability to manage a high-volume work queue, organize competing deadlines, and escalate risks promptly.
• High attention to detail when validating member identifiers, dates of service, provider information, record completeness, and document quality.
• Working knowledge of HIPAA, protected health information, secure file transmission, and medical record confidentiality requirements.
• Basic understanding of Medicare Advantage Risk Adjustment, HCC validation, retrospective review, Level 2 review, and RADV preferred.
• Proficiency with Microsoft Outlook, Excel, Word, Teams, electronic fax, provider portals, workflow systems, and document imaging tools.
• Ability to maintain accurate tracking logs, analyze retrieval status, and communicate actionable updates.
• Ability to work independently, collaborate across departments, and maintain a customer-service mindset with providers and internal partners.
• Bilingual capability aligned with provider network needs is a plus.

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.
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking).
• Ability to sit for long periods; stand, sit, reach, bend, and lift up to fifteen (15) lbs.

Ability to express or exchange ideas to obtain information, explain detailed record requests, and communicate instructions accurately and promptly. Work is performed in an office environment, remotely, and occasionally at provider locations. The job involves frequent contact with provider office staff, vendors, and internal departments. May occasionally be required to work irregular hours based on audit deadlines or business needs.

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.