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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.
The Medical Records Retrieval Specialist performs moderately complex administrative and operational tasks in a remote and field‑based, structured environment, with a focus on accuracy, compliance, and efficiency.
Use your skills to make an impact
Scheduled Hours:
- The normal business hours for this position are Monday – Friday from 8:00 am – 4:30 pm EST.
- Occasional schedule flexibility may be required to support business needs.
What You'll Do:
- 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.
Travel Requirements:
- Reside within Sumter, SC or surrounding areas; specifically, Orangeburg, Bamberg, Hampton, Allendale, Colleton, Calhoun, OR Beaufort.
- 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.
Required Qualifications
- 1 or more years of customer service experience.
- 1 or more years with medical records.
- Use Microsoft Teams and Outlook daily to coordinate meetings, manage calendars, and communicate with supervisor and peers.
- Experience handling a high volume of tasks and follow up and maintaining a high standard of professional conduct.
- 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.)
- 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
- 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.
Additional Information
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
- If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
- If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
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, volunteer time off, 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.
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.
