# Records Retrieval Specialist (Risk Adjustment Rep. 2)

**Company**: Humana Inc.
**Location**: Remote Virginia
**Work arrangement**: remote
**Job type**: full-time
**Salary**: $40,000 - $52,300 per year
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Virginia/Records-Retrieval-Specialist_R-435565?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_f31d0e8f-22e

## Description

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 extensive field-based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on-site in or around the Northern Virginia territory, reporting directly to the Risk Adjustment Supervisor.

**Scheduled Hours:**

- Monday – Friday from 8:00 am – 5:00 pm EST

- Occasional schedule flexibility may be required to support business needs.

**What Success Looks Like:**

- Accurately collect, validate, and reconcile medical records to ensure complete and accurate member information, including obtaining required provider signatures.

- Upload verified documentation to the Cotiviti centralized repository while maintaining data integrity and quality standards.

- Consistently adhere to state and federal regulations, HIPAA requirements, and internal policies when retrieving, handling, and storing medical records.

- Apply departmental procedures and guidelines effectively to complete assignments accurately, efficiently, and with minimal rework.

- Utilize company-issued technology, including laptops, portable scanners, and encrypted storage devices, to securely retrieve and manage medical records.

- Proactively engage physician offices through high-volume phone and email outreach to obtain records and meet operational deadlines.

- Maintain strict confidentiality and safeguard protected health information (PHI) at all times.

- Successfully manage a high-volume workload independently while consistently meeting productivity, quality, and service-level expectations.

**Travel Requirements:**

- Reside within Northern Virginia in one of the following counties: Arlington, Fairfax, Prince William, or Loudoun.

- Extensive travel up to 75% and occasionally stay overnight, as needed.

- Must have a valid driver's license and reliable transportation.

**Required Qualifications**

- 1 or more years of experience in customer service.

- 1 or more years of experience with medical records.

- 1 or more years of experience using Microsoft 365 and associated applications, such as Teams and Outlook daily to coordinate meetings, manage calendars, and support internal communication.

- Experience managing high-volume workloads while ensuring prompt follow-up and adherence to professional standards.

- Experience articulating information to internal peers and external partners.

- Experience in health care environment/managed care (provider office, billing, coding, release of information, etc.)

**Preferred Qualifications**

- 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.

**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.

**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.

## Skills

### Required
- Microsoft 365
- customer service
- medical records
- healthcare environment
- managed care

### Nice to have
- ICD-9/10 codes
- medical terminology
- EMR systems

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Source: [Apply at humana.wd5.myworkdayjobs.com](https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Virginia/Records-Retrieval-Specialist_R-435565?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)