Medical Records Representative

Humana • Meridian, ID

3d • Hybrid

About The Position

The Medical Records Representative (Risk Adjustment Representative 3) retrieves medical records from provider offices for a variety of reviews and audits through various retrieval methods. This role requires residing within Boise or Meridian, Idaho, with travel up to 50% statewide, including occasional overnight travel for up to one week at a time. The position also has specific work-from-home requirements, including a dedicated space and minimum internet speeds, and may require occasional travel to Humana's offices for training or meetings.

Requirements

• 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.)
• Must have a valid driver's license and reliable transportation.
• 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.
• Self-provided internet service must meet at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• 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.

Responsibilities

• 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.

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed