Records Retrieval Specialist - PA/NJ

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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 field-based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on site in Pennsylvania and its surrounding counties, reporting directly to the Risk Adjustment Supervisor.

As the Medical Records Retrieval Specialist (Risk Adjustment Representative 2) you will:

Collect medical records and conduct research to ensure accuracy of member information and obtain provider signatures.

Travel will consist of driving to locations close to your home in an assigned territory and other areas as needed. Overnight travel may be required within the assigned territory on occasion.

Collaborate with provider offices through phone calls and visits.

Use multiple EMR systems to access records following all HIPAA guidelines.

Use a laptop computer, portable scanner, and external thumb drive to retrieve medical records which will be uploaded into a database.

Schedule appointments and visits to physician offices in a timely, efficient manner to meet all deadlines.

Will assist with regional phone calls and administrative projects.

Scheduled Hours

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.

Travel Requirements

Reside in PA within one of the following counties: Chester, Delaware, Montgomery, or Philadelphia.

Must be available to travel up to 100% in assigned territory across Pennsylvania and New Jersey markets, and occasionally stay overnight, as needed.

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

Required Qualifications

1 or more years of experience working with various Electronic Medical Records (EMR) systems.

1 or more years of experience in a hospital and/or provider setting.

Ability to travel overnight occasionally within the region (Northeast).

This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.

Preferred Qualifications

Experience using Microsoft 365 and associated applications including Word, Excel, and Teams.

Previous experience in a managed care setting.

Familiarity with medical terminology and/or ICD-10 codes.

Medical record retrieval experience.

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 interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.