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The Records Retrieval Specialist (Risk Adjustment Rep. 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 Pennsylvania and its surrounding counties, reporting directly to the Risk Adjustment Supervisor.

As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will:

• Collect medical records and conduct research to ensure accuracy of member information and obtain provider signatures.
• Travel will consist of driving to locations close to your home in an assigned territory and other areas as needed. Overnight travel may be required within the assigned territory on occasion.
• Collaborate with provider offices through phone calls and visits.
• Use multiple EMR systems to access records following all HIPAA guidelines.
• Use a laptop computer, portable scanner, and external thumb drive to retrieve medical records which will be uploaded into a database.
• Schedule appointments and visits to physician offices in a timely, efficient manner to meet all deadlines.
• Will assist with regional phone calls and administrative projects.

Use your skills to make an impact
 

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.

Travel Requirements:

• Reside in PA within one of the following counties: Chester, Delaware, Montgomery, or Philadelphia.
• Must be available to travel up to 100% in assigned territory across Pennsylvania and New Jersey markets, and occasionally stay overnight, as needed.
• Must have reliable car transportation and a valid driver's license.

Required Qualifications

• 1 or more years of experience working with various Electronic Medical Records (EMR) systems.
• 1 or more years of experience in a hospital and/or provider setting.
• Ability to travel overnight occasionally within the region (Northeast).
• This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.

Preferred Qualifications

• Experience using Microsoft 365 and associated applications including Word, Excel, and Teams.
• Previous experience in a managed care setting.
• Familiarity with medical terminology and/or ICD-10 codes.
• Medical record retrieval experience.
  

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.

 

$44,000 - $57,500 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.

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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.