Remote Medical Records Specialist - Risk Adjustment

Humana; Boise (ID); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is seeking a Medical Records Representative to retrieve and validate medical records for risk adjustment reviews and audits. You will handle provider communications and ensure PHI protection while maintaining accuracy and data integrity.

Based in Boise/Meridian, Idaho, the role requires traveling up to 50% statewide and frequent use of Humana tools for secure record handling. A 40-hour work week with remote work flexibility is typical.

Qualifications

• 1+ years of experience in customer service.
• 1+ years of experience with medical records.
• Experience using Microsoft 365 daily (Teams, Outlook).
• Ability to work independently and solve problems.
• Knowledge of HIPAA/PHI handling and healthcare compliance.
• Experience managing high-volume workloads and meeting deadlines.

Responsibilities

• Accurately collect, validate, and reconcile medical records.
• Upload verified documentation to Humana's central repository.
• Ensure compliance with HIPAA and internal policies in handling PHI.
• Engage provider offices via high-volume phone and email outreach to obtain records.
• Maintain data integrity and meet productivity and quality standards.

Skills

Customer service

Medical records

Microsoft 365

PHI / HIPAA compliance

High-volume workload

Provider communications

Tools

Epic EMR

Microsoft 365

Teams

Outlook

Job description

Humana is seeking a Medical Records Representative to retrieve and validate medical records for risk adjustment reviews and audits. You will handle provider communications and ensure PHI protection while maintaining accuracy and data integrity.

Based in Boise/Meridian, Idaho, the role requires traveling up to 50% statewide and frequent use of Humana tools for secure record handling. A 40-hour work week with remote work flexibility is typical.