Risk Adjustment Senior Chart Retrieval Specialist
Blue Cross Blue Shield of Kansas

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

You Belong At Blue

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 401(k) plan matching up to 5%
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Job Summary

The Senior Chart Retrieval Specialist is responsible for managing high-volume, complex, and audit-sensitive medical record retrieval operations in support of Affordable Care Act (ACA), Medicare Advantage (MA), Risk Adjustment (RA) and quality initiatives. This role operates with a high degree of autonomy and professional judgement overseeing daily retrieval activities, serves as a subject matter expert on chart retrieval systems and processes, supports provider relationships and escalations, and ensures data integrity, productivity, and audit readiness. The Senior Chart Retrieval Specialist identifies, assesses, and mitigates retrieval and documentation risk, partners closely with coding teams and management to protect audit outcomes and regulatory compliance.

"This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

What you'll do

• Own daily chart retrieval operations, managing high volume and complex workloads while prioritizing work based on regulatory risk, data integrity, and submission timelines.
• Coordinate maintenance and improvement to chart retrieval system with other internal stakeholders including Government Programs, Information Technology and Health Analytics.
• Handle high-volume and/or complex provider networks, including coordination of special EMR/EHR integrations and access requirements.
• Serve as the subject matter expert (SME) on chart retrieval systems, workflows, and procedures.
• Train, mentor, and support Chart Retrieval Specialists by providing expert guidance on complex cases, quality standards, and compliance expectations, without formal supervisory responsibility.
• Prepare and present project status updates to leadership, clearly communicating risks and issues and recommending mitigation strategies as needed.
• Independently resolve high risk or delayed retrieval issues when within scope; escalate to management when issues exceed defined risk thresholds or require policy interpretation.
• Collaborate closely with coding teams to ensure complete, accurate, and audit-ready medical record submissions.
• Maintain accurate documentation to support internal reporting, audits, and regulatory compliance.
• Coordinate and maintain mock-RADV process completion and reporting.

What you need

Education and Experience:

• High School Diploma or equivalent is required
• Minimum of 4 years of experience in medical record/chart retrieval, preferably in Risk Adjustment, HEDIS, or quality initiatives including experience handling complex or audit sensitive retrieval scenarios required
• Demonstrated knowledge of CMS, MA, and HEDIS documentation requirements and compliance standards required
• Proven experience managing provider relationships, handling escalations, and prioritizing high-volume workloads required
• 2+ years' experience managing Risk Adjustment charts preferred
• Prior experience training, mentoring, or supervising chart retrieval staff preferred
• Familiarity with CMS audits (RADV), internal audits, or compliance reviews preferred
• CPC/CRC Certification preferred

Knowledge/Skills/Abilities:

• Demonstrated ability to interpret regulatory requirements and apply professional judgment to complex, non-standard retrieval scenarios
• Manages complex and non-responsive provider outreach and escalations across multiple health systems
• Demonstrates expert knowledge of CMS, ACA, and Medicare Advantage Risk Adjustment requirements
• Builds and maintains strong relationships with provider offices and health system staff
• Apply strong analytical and organizational skills to prioritize high-risk chases and manage timelines
• Ensures strict adherence to HIPAA, CMS audit standards, and data security policies

Compensation

$30.96 - $38.70
Non-exempt Grade 14

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.

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