Records Retrieval Specialist

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 extensive field-based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on-site in or around the Smyth County, VA area, 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, focusing on accuracy, compliance, and efficiency to support positive member and provider outcomes.

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

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

• 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 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.

• Reside within Smyth County, VA or bordering counties:
  Russell, Tazewell, Bland, Wythe, Grayson, or Washington counties.

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

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

• 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.)
• 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.

• 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.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid…