Records Retrieval Specialist

Humana; Virginia; Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Job summary

Humana is seeking a Medical Records Retrieval Specialist for a remote role with extensive field travel to provider offices near Smyth County, VA. You will retrieve, review, and validate records for CMS and other government agencies, ensuring accuracy and timely submission.

You will perform quality assurance audits, maintain HIPAA compliance, and securely upload documents to Cotiviti repository while protecting PHI and meeting deadlines.

Qualifications

• 1+ year of customer service experience.
• 1+ year of experience with medical records.
• 1+ year using Microsoft 365 apps (Teams, Outlook).
• Experience handling high-volume workloads with prompt follow-up.
• Experience communicating with internal and external partners.
• Experience in health care environment/managed care.

Responsibilities

• Collect, validate, and reconcile medical records accurately.
• Upload verified documentation to Cotiviti repository.
• Adhere to HIPAA and federal/state regulations.
• Retrieve records via high-volume phone and email outreach to provider offices.
• Maintain confidentiality of PHI at all times.
• Travel up to 75% and work remotely from Smyth County area as needed.

Skills

Customer service

Medical records

Microsoft 365

Phone outreach

EMR systems

HIPAA compliance

Communication

High-volume workload management

Tools

Microsoft Teams

Outlook

EMR systems

Job 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.

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.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities.

About Us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.