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The Medical Records Retrieval Specialist conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies. This remote role involves significant field responsibility, requiring travel to provider offices in West Virginia to retrieve, review, and validate medical records on-site.
Typical schedule is Monday to Friday, 8:00 am to 5:00 pm EST, with occasional flexibility.
Responsibilities include:
- Collecting medical records to ensure accuracy of member information and obtaining provider signatures
- Uploading verified documents to Cotiviti centralized repository
- Following state/federal regulations and internal policies for medical record retrieval
- Using laptops, portable scanners, and encrypted flash drives to handle medical records
- Communicating with physician offices by phone and email to meet deadlines
- Maintaining confidentiality and safeguarding PHI in compliance with HIPAA
- Managing workload independently within service level expectations
Travel up to 40% required, primarily in specified West Virginia counties. Reliable transportation and valid driver's license with vehicle insurance are required.
Qualifications:
- 1+ years of customer service experience
- 1+ years experience with medical records
- Proficiency with Microsoft Teams and Outlook
- Experience managing high task volume and articulating information to stakeholders
- Healthcare environment or managed care knowledge (billing, coding, release of information etc.)
Preferred:
- Bachelor's degree related field
- Knowledge of ICD-9/10 codes and medical terminology
- Experience with EMR systems
Must have high-speed internet at home and a dedicated space protecting PHI. Occasional travel to Humana offices for training may be required.
Humana offers comprehensive benefits including medical, dental, vision, 401(k), paid time off, parental leave, disability, and life insurance.
About Humana: A leading U.S. healthcare company providing insurance and healthcare services to millions including Medicare and Medicaid beneficiaries.
- Minimum of 1 year customer service experience
- Minimum of 1 year experience with medical records
- Proficient in Microsoft Teams and Outlook
- Experience handling high task volume across workflows
- Ability to communicate effectively with internal and external stakeholders
- Knowledge or experience in healthcare environment or managed care (provider office, billing, coding, release of information, etc.)
- Valid state driver's license with personal vehicle liability insurance as required
Preferred:
- Bachelor's degree in related field
- Knowledge of ICD-9/10 codes and medical terminology
- Experience with EMR systems
Humana offers competitive benefits including medical, dental, vision coverage, 401(k) retirement plan, paid time off (vacation, holidays, volunteer time off), paid parental and caregiver leave, short-term and long-term disability insurance, life insurance, and additional wellness programs.
Location
West Virginia, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$40,000 - $52,300
Remote work allowed
Yes
Posted
4 weeks ago