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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 field‑based responsibility, requiring travel to provider offices to retrieve, review, and validate medical records on‑site in or around the South Bend, IN area.

The Medical Records Retrieval Specialist performs moderately complex administrative and operational tasks in a remote and field‑based, structured environment, with a focus on accuracy, compliance, and efficiency.

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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.

Duties and Responsibilities

• Collect medical records to ensure accuracy of member information and obtain provider signatures.
• Upload verified documents to Cotiviti centralized repository.
• Follow state and federal regulations as well as internal policies and guidelines while retrieving medical records.
• Interpret and apply departmental procedures to complete assignments with accuracy and efficiency.
• Use a laptop computer and a portable scanner and encrypted flash drive to retrieve medical records which will be uploaded into a database.
• Communicate with physician offices by phone and email to efficiently meet all deadlines.
• Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines.
• Independently manage workload within defined service level expectations.

Travel Requirements:

• Must reside within a 50-mile radius of South Bend, Indiana.
• Ability to travel up to 40% of the time at peak season, as needed.
• Must have reliable transportation.

Required Qualifications

• Minimum 1 or more years of customer service experience.
• Minimum 1 or more years with medical records.
• Use Microsoft Teams and Outlook daily to coordinate meetings, manage calendars, and support internal communication.
• Experience handling high task volume across parallel workflows consistently, follow up, and a high standard of professional conduct.
• Experience articulating information to internal stakeholders and external partners.
• Knowledge or 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.

Preferred Qualifications

• Bachelor's degree in a related field.
• 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.

Additional Information

Work at Home Guidance

• Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet services are NOT permitted for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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

Scheduled Weekly Hours

40

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 geogr