Medical Records Representative

Become a part of our caring community

The Medical Records Representative (Risk Adjustment Representative
3) retrieves medical records from provider offices for a variety of reviews and audits through various retrieval methods.

Scheduled

Hours:

• The normal business hours for this position are Monday – Friday from 8:00 am – 5:00 pm MST.

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

What Success Looks Like:

• You will 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 follow 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 Humana-issued technology, including laptops, portable scanners, and encrypted storage devices, to securely retrieve and manage medical records.

• 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 Boise or Meridian, Idaho.

• Travel up to 50% statewide, including occasional overnight travel for up to one week at a time, as needed.

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

Use your skills to make an impact

What You’ll Bring

• 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 working independently, thinking strategically, and applying problem-solving while considering the broader impact across the enterprise.

• 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.)

• 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.

What Will Help You Stand Out

• Experience in health care environment/managed care.

• Experience and comfort with Epic and other EMR systems.

• Knowledge of ICD-9/10 codes.

• Knowledge of medical terminology.

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…