Medical Records Representative

Medical Records Representative (Risk Adjustment Representative 3)

The Medical Records Representative 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.

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 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.

Scheduled Weekly Hours

40

Pay Range

$43,000 - $56,200 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, 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 CenterWell 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 CenterWell.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.