Radv Audit Jobs in Minnesota (NOW HIRING)

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.
We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.
Medica's Medical Record Retrieval Specialist collects, reviews, and manages medical records to support clinical reviews, quality programs, and regulatory audits. This role ensures records are obtained accurately, on time, and in compliance with audit and privacy requirements.
The specialist works closely with internal clinical and audit teams and external provider offices to resolve documentation gaps, track retrieval status, and maintain audit-ready records. The ideal candidate is organized, detail-oriented, and able to manage multiple priorities. Perform other duties assigned.
Key Responsibilities
Record Retrieval & Coordination

• Request and retrieve medical records from provider offices, health systems, vendors, and EHR platforms (e.g., Epic, Cerner) using phone, email, fax, portals, and approved systems
• Support HEDIS Hybrid Reviews, CMS Cost Audits, RADV, Data Validation, and other clinical or audit reviews
• Follow established retrieval timelines, protocols, and escalation processes
• Identify and escalate missing, incomplete, or delayed records

Record Review & Validation

• Review records for completeness, legibility, required date ranges, and relevance
• Identify documentation gaps and coordinate follow-ups with providers
• Validate records against audit and project requirements
• Partner with clinical reviewers, auditors, and data teams to clarify documentation needs

Data Management & Tracking

• Upload, index, and organize records in designated systems (e.g., SharePoint, internal audit tools)
• Ensure accurate file naming, version control, and proper record association
• Track retrieval status, provider responses, and outstanding requests
• Perform quality checks to ensure records are audit-ready
• Maintain real-time tracking of retrieval status, provider responses, and outstanding requests

Communication & Compliance

• Serve as a point of contact for providers regarding record requests and submissions
• Provide status updates to internal stakeholders
• Document outreach and escalation activities
• Handle PHI in accordance with HIPAA, CMS, and organizational policies
• Use approved secure methods for record transmission and storage

Required Qualifications

• High school diploma or equivalent experience
• 2 years of experience in medical record retrieval, healthcare operations, clinical support, or related field
• Proficiency with Adobe Acrobat and Microsoft Office (Outlook, Excel, SharePoint, Teams)

Preferred Qualifications

• Excellent verbal and written communication skills
• Strong organizational, time management, and communication skills
• Ability to manage multiple priorities independently
• Associate degree or higher in Health Information Management or related field
• Experience with HEDIS, CMS Cost Audits, RADV, or other regulatory audits
• Familiarity with EHR systems (e.g., Epic, Cerner) and secure document exchange platforms
• Experience working with provider offices or HIM departments
• Knowledge of healthcare quality measures or regulatory documentation standards

This position is a Remote role. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.
The full salary grade for this position is $41,300 - $70,800. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $41,300 - $61,950. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.