Remote Medical Records Retrieval & Compliance Specialist

Humana; United States; Remote; USD 40.000 - 52.000; Vollzeit

Zusammenfassung

Humana is seeking a Medical Records Retrieval Specialist to perform quality assurance audits on medical records and ICD-9/10 codes for CMS and other agencies. This remote role requires on-site travel to provider offices around Smyth County, VA, reporting to the Risk Adjustment Supervisor.

The role emphasizes accuracy, HIPAA compliance, and efficient processing in a field-based, structured environment. You will securely handle PHI and coordinate with physician offices to meet deadlines while

Qualifikationen

• 1+ year of experience in customer service.
• 1+ year of experience with medical records.
• Proficient with Microsoft 365 including Teams and Outlook.
• Experience managing high-volume workloads with prompt follow-up.
• Ability to articulate information clearly to internal and external partners.
• Experience in health care/managed care environments.
• Must hold a valid state driver's license and maintain vehicle insurance.

Aufgaben

• Collect, validate, and reconcile medical records to ensure complete member information.
• Upload verified documentation to Cotiviti repository maintaining data integrity.
• Adhere to HIPAA, state and federal regulations and internal policies.
• Follow departmental procedures to complete assignments accurately with minimal rework.
• Use company devices to securely retrieve and manage medical records.
• Engage physician offices via high-volume calls and emails to obtain records.
• Maintain strict confidentiality of PHI.
• Manage a high-volume workload independently meeting productivity and quality targets.

Kenntnisse

Customer service

Medical records

High-volume workload management

HIPAA compliance

PHI handling

Provider outreach

Tools

Microsoft 365

Teams

Outlook

EMR systems

Jobbeschreibung

Humana is seeking a Medical Records Retrieval Specialist to perform quality assurance audits on medical records and ICD-9/10 codes for CMS and other agencies. This remote role requires on-site travel to provider offices around Smyth County, VA, reporting to the Risk Adjustment Supervisor.

The role emphasizes accuracy, HIPAA compliance, and efficient processing in a field-based, structured environment. You will securely handle PHI and coordinate with physician offices to meet deadlines while