Description
Become a part of our caring community
The Medical Records Retrieval Specialist conducts quality assurance audits of medical records and ICD‑9/10 diagnosis codes submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. This is a remote role with extensive field‑based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on‑site in or around the Smyth County, VA area, reporting directly to the Risk Adjustment Supervisor.
The Medical Records Retrieval Specialist performs moderately complex administrative and operational tasks in a remote and field‑based, structured environment, focusing on accuracy, compliance, and efficiency to support positive member and provider outcomes.
Use your skills to make an impact
Scheduled Hours:
- The normal business hours for this position are Monday – Friday from 8:00 am – 5:00 pm EST.
- Occasional schedule flexibility may be required to support business needs.
What Success Looks Like:
- You will accurately collect, validate, and reconcile medical records to ensure complete and accurate member information, including obtaining required provider signatures.
- Upload verified documentation to the Cotiviti centralized repository while maintaining data integrity and quality standards.
- Consistently adhere to state and federal regulations, HIPAA requirements, and internal policies when retrieving, handling, and storing medical records.
- Apply departmental procedures and guidelines effectively to complete assignments accurately, efficiently, and with minimal rework.
- Utilize company-issued technology, including laptops, portable scanners, and encrypted storage devices, to securely retrieve and manage medical records.
- Proactively engage physician offices through high-volume phone and email outreach to obtain records and meet operational deadlines.
- Maintain strict confidentiality and safeguard protected health information (PHI) at all times.
- Successfully manage a high-volume workload independently while consistently meeting productivity, quality, and service-level expectations.
Travel Requirements:
- Reside within Smyth County, VA or bordering counties: Russell, Tazewell, Bland, Wythe, Grayson, or Washington counties.
- Extensive travel up to 75% and occasionally stay overnight, as needed.
- Must have a valid driver's license and reliable transportation.
What You'll Bring
- 1 or more years of experience in customer service.
- 1 or more years of experience with medical records.
- 1 or more years of experience using Microsoft 365 and associated applications, such as Teams and Outlook daily to coordinate meetings, manage calendars, and support internal communication.
- Experience managing high-volume workloads while ensuring prompt follow-up and adherence to professional standards.
- Experience articulating information to internal peers and external partners.
- Experience in health care environment/managed care (provider office, billing, coding, release of information, etc.)
- This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individuals must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
What Will Help You Stand Out
- Knowledge or experience in health care environment/managed care.
- Knowledge of ICD-9/10 codes.
- Knowledge of medical terminology.
- Experience and comfort with EMR systems.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
