Records Retrieval Specialist
About the role
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 field-based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on-site in or around the Sumter, SC area and surrounding counties, reporting directly to the Risk Adjustment Supervisor.
Responsibilities
- Collect medical records and conduct research to ensure accuracy of member information and obtain provider signatures.
- Upload verified documents to Cotiviti centralized repository within 24-hour time frame.
- 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.
- Conduct a high volume of calls to 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.
Requirements
- Reside within South Carolina.
- MUST be able to travel and occasionally stay overnight up to 60% of the time at peak season, as needed.
- Must have reliable car transportation.
Qualifications
- 1 or more years of customer service experience.
- 1 or more years with medical records.
- Experience handling a high volume of tasks and following up.
- Experience articulating information to internal peers and external partners.
- Knowledge or experience in a health care environment/managed care (provider office, billing, coding, release of information, etc.).
Preferred Qualifications
- Associate's degree or higher in a related field.
- 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.
Benefits
Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, a 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.
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 at Humana.com and at CenterWell.com.