Medical Record Retrieval Specialist - Denver, CO

Humana • Colorado Springs, CO

1d • Remote

About The Position

The Medical Records Retrieval Specialist conducts quality assurance audits of medical records and diagnosis codes and measures submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. This is a remote role with field‑based responsibility, requiring some travel to provider offices to retrieve, review, and validate medical records on‑site. The Medical Records Retrieval Specialist performs moderately complex administrative and operational tasks within a structured environment, with a focus on accuracy, compliance, and efficiency.

Requirements

• 1 or more years of customer service experience.
• 1 or more years with medical records.
• Experience using Microsoft Teams and Outlook.
• Strong written and verbal communication skills with the ability to clearly articulate information to internal stakeholders and external partners.
• Knowledge and 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.
• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• 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.

Responsibilities

• Review, upload, and analyze medical records to ensure accuracy of member information and obtain provider signatures.
• Manage top priorities while maintaining a consistent level of organization, follow up, and a high standard of professional conduct.
• Conduct quality assurance audits with predefined health measures for CMS and other government agencies.
• Interpret and apply departmental procedures to complete assignments with accuracy.
• Independently manage workload tasks within defined service level expectations.
• Identify discrepancies in documentation and take appropriate action to resolve.
• Support provider-facing education efforts related to documentation and coding accuracy, as needed.
• Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees