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.