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:
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The normal business hours for this position are Monday – Friday from 8:00 am – 5:00 pm CST.
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Occasional schedule flexibility may be required to support business needs.
Travel Requirements:
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Must reside within Montgomery, AL or surrounding areas; specifically, Pike, Crenshaw, Butler, Bullock, Lowndes, Autauga, or Elmore counties.
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Ability to travel up to 50% of the time at peak season, as needed.
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Must have reliable transportation.
What You'll Do:
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You will collect medical records to ensure accuracy of member information and obtain provider signatures.
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Upload verified documents to Cotiviti centralized repository.
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Follow state and federal regulations as well as internal policies and guidelines while retrieving medical records.
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Interpret and apply departmental procedures to complete assignments with accuracy and efficiency.
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Use a laptop computer and a portable scanner and encrypted flash drive to retrieve medical records which will be uploaded into a database.
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Communicate with physician offices by phone and email to efficiently meet all deadlines.
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Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines.
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Independently manage workload within defined service level expectations.
Required Qualifications
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1 or more years of customer service experience.
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1 or more years with medical records experience.
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Knowledge or experience in health care environment/managed care (provider office, billing, coding, release of information, etc.).
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Experience utilizing Microsoft Teams and Outlook daily to coordinate meetings, manage calendars, and support internal communication.
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Experience handling high task volume across parallel workflows consistently, follow up, and a high standard of professional conduct.
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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.
Preferred Qualifications
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Bachelor's degree in a related field.
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Knowledge of ICD-9/10 codes.
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Knowledge of medical terminology.
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Experience and comfort with EMR systems.
Additional Information
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.
$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 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.
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.
