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 field-based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on-site in or around the Wilmington area.
This role performs moderately complex administrative and operational tasks in a remote and field-based, structured environment, focusing on accuracy, compliance, and efficiency.
Normal business hours are Monday – Friday from 8:00 am – 5:00 pm EST. Occasional schedule flexibility may be required.
Responsibilities include:
- Collecting medical records and conducting research to ensure accuracy of member information and obtain provider signatures.
- Uploading verified documents to Cotiviti centralized repository.
- Following state and federal regulations as well as internal policies and guidelines.
- Using laptops, portable scanners, and encrypted flash drives to retrieve and upload medical records.
- Conducting high volumes of calls to physician offices by phone and email to meet deadlines.
- Maintaining strict confidentiality and safeguarding protected health information (PHI) per HIPAA guidelines.
- Independently managing workload within service level expectations.
Travel requirements:
- Must reside in Wilmington, NC area (Carolina Beach, Castle Hayne, Hampstead, Leland, Shallotte, Southport, or Wrightsville Beach).
- Able to travel and occasionally stay overnight up to 50% of the time during peak season.
- Must have reliable transportation.
Required qualifications:
- Minimum one year customer service experience.
- Minimum one year experience with medical records.
- Daily use of Microsoft Teams and Outlook.
- Experience managing high task volume and professional conduct.
- Experience communicating with internal and external stakeholders.
- Knowledge or experience in healthcare environment/managed care (billing, coding, release of information, etc.).
- Valid driver’s license and personal vehicle insurance as per state requirements.
Preferred qualifications:
- Bachelor's degree in a related field.
- Knowledge of ICD-9/10 codes and medical terminology.
- Experience and comfort with EMR systems.
Additional info:
- Work from home requires reliable internet (min 25 Mbps down, 10 Mbps up).
- Training or meetings may require occasional travel to Humana offices.
Scheduled weekly hours: 40
Pay range: $40,000 - $52,300 per year
Benefits: Humana offers medical, dental, vision benefits, 401(k), paid time off including parental leave, disability, life insurance, and more.
About Humana: Leading U.S. healthcare company delivering services to improve quality of life for Medicare, Medicaid recipients and others.
- Minimum 1+ years customer service experience.
- Minimum 1+ years experience with medical records.
- Knowledge or experience in healthcare/managed care environments.
- Valid driver's license and personal vehicle insurance.
- Experience with Microsoft Teams and Outlook.
- Ability to manage high-volume tasks and maintain professional communication.
Preferred:
- Bachelor's degree in related field.
- Knowledge of ICD-9/10 codes and medical terminology.
- Experience with EMR systems.
Humana offers a comprehensive benefits package including medical, dental, and vision insurance, 401(k) retirement savings plan, paid time off (including parental and caregiver leave), short-term and long-term disability, life insurance, and programs supporting whole-person well-being.
Location
North Carolina, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$40,000 - $52,300
Remote work allowed
Yes
Posted
4 weeks ago