Records Retrieval Representative

Become a part of our caring community   The Medical Records Retrieval Representative (Risk Adjustment Representative 2) 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 Montgomery, AL. The Medical Records Retrieval Representative performs moderately complex administrative and operational tasks in a remote and field‑based, structured environment, with a focus on accuracy, compliance, and efficiency. You will report to the Supervisor, Risk Adjustment Administration. Work Schedule: The normal business hours for this position are Monday – Friday from 8:00 am – 5:00 pm CST. Occasional schedule flexibility may be required to support business needs.

Must reside within Montgomery, AL or surrounding areas; specifically, Pike, Crenshaw, Butler, Bullock, Lowndes, Autauga, or Elmore counties. Ability to travel up to 50% of the time at peak season, as needed. Must have reliable transportation.

You will collect medical records to ensure accuracy of member information and obtain provider signatures. Upload verified documents to Cotiviti centralized repository. Follow state and federal regulations as well as internal policies and guidelines while retrieving medical records. Interpret and apply departmental procedures to complete assignments with accuracy and efficiency. Use a laptop computer and a portable scanner and encrypted flash drive to retrieve medical records which will be uploaded into a database. Communicate with physician offices by phone and email to efficiently meet all deadlines. Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines. Independently manage workload within defined service level expectations. Use your skills to make an impact   Required Qualifications 1 or more years of customer service experience. 1 or more years with medical records experience. Knowledge or experience in health care environment/managed care (provider office, billing, coding, release of information, etc.). Experience utilizing Microsoft Teams and Outlook daily to coordinate meetings, manage calendars, and support internal communication. Experience handling high task volume across parallel workflows consistently, follow up, and a high standard of professional conduct. 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.

Bachelor's degree in a related field. 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.