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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.

Use your skills to make an impact 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 Hire Vue to enhance our hiring and decision-making ability. Hire Vue 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 geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our Center Well healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at Center Well.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.