Risk Adjustment Representative

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Overview

The position of Risk Adjustment Representative at Humana plays a critical role within the healthcare sector. It involves conducting thorough quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to agencies like the Centers for Medicare and Medicaid Services (CMS). This job opportunity allows you to become part of a dedicated team that aims to improve healthcare outcomes through accurate coding and compliance.

Job Responsibilities

As a Risk Adjustment Representative 2, your primary responsibilities include:

• Conducting quality assurance audits of medical records.
• Analyzing ICD-9/10 diagnosis codes to ensure they are accurate and well-supported by clinical documentation.
• Following state and federal regulations along with internal policies while analyzing coding information and medical records.
• Participating in provider education programs related to coding compliance.
• Performing moderately complex administrative, operational, and customer support tasks.
• Occasionally traveling to the office located in Charlotte, NC for training and team meetings, and to procure records from various provider locations.

Required Qualifications

To qualify for this position, candidates should have:

• A minimum of 6 months of medical record retrieval experience.
• Prior experience in customer service within a healthcare environment.
• Proficiency in Microsoft Office applications, particularly Word and Excel.
• A valid driver's license and proof of personal vehicle liability insurance with minimum coverage of 100/300/100, as driving may be necessary.

Preferred Qualifications

While not mandatory, the following qualifications are preferred:

• A Bachelor's Degree.
• Strong verbal and written communication skills.
• Analytical, organizational, and time management capabilities.
• Experience in a managed care setting and knowledge of ICD-9/10 coding.

Work Environment

This position is predominantly remote, with occasional travel to the office for training or meetings. The employee must ensure that their internet connection meets specific guidelines — a minimum download speed of 25 Mbps and upload speed of 10 Mbps. A dedicated workspace is also necessary to protect member information as per HIPAA compliance.

Salary and Benefits

Humana offers a competitive salary, ranging from $40,000 to $52,300 per year, depending on location and individual qualifications. The estimated pay reflects the starting base pay for full-time employment at the time of posting. Encompassed within the employment package are enticing benefits geared towards enhancing the overall well-being of employees, including:

• Health, dental, and vision coverage.
• A comprehensive 401(k) retirement savings plan.
• Paid time off that consists of holidays and parental/caregiver leave.
• Short-term and long-term disability benefits.
• Life insurance and various other professional growth opportunities.

About Humana

Founded in 1961, Humana Inc. is a leading healthcare company in the United States. The organization's mission is centered around delivering healthcare solutions ideally suited for Medicare and Medicaid recipients while emphasizing wellness and quality of life for individuals and communities. Their commitment to a whole-person health approach makes them a respected player in the healthcare space.

Equal Opportunity Employer

Humana is committed to fostering a workplace that is inclusive and diverse. They adhere to equal opportunity employment practices, ensuring no discrimination based on race, gender, religion, age, or disability. The selection and employment processes are grounded on validated job requirements, striving to promote equality in all employment actions.

Conclusion

If you're looking to advance your career in healthcare compliance and have a solid background in medical record management and coding, consider applying for the Risk Adjustment Representative position at Humana. You can make a significant impact in ensuring accurate health records and supporting top-notch care for individuals across the United States.

This job offer was originally published on himalayas.app