Risk Adjustment Admin Professional

Humana

1d • $59,300 - $80,900 • Hybrid

About The Position

The Risk Adjustment Administration Professional 1 is responsible for uploading packets for CMS RADV (Risk Adjustment Data Validation) to CDAT (Central Data Abstraction Tool). This role also involves administrative review, claims review/investigation, and collaboration with different teams, including the retrieval team. Work assignments are often straightforward and of moderate complexity. The professional may conduct analysis of data uploaded to CMS, review of packets, and some claims review. They understand professional concepts/standards, regulations, strategies, and operating standards within their work area. Decisions regarding work approach and priorities are made, and direction is followed. Work is driven by CMS deadlines and is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Requirements

• 2+ years of Microsoft Excel experience
• Software/applications navigation skills
• Cross validation of data sets experience
• Ability to verify member data matches prior to upload
• Self-motivated: Takes initiative, works with minimal supervision
• Team player: Helps other team members after completing assigned work; asks for additional work when needed.

Nice To Haves

• CAS – claims experience reviewing and understanding
• Deadline driven – prioritizing task to meet internal/external deadlines
• Task oriented – completing assigned work and prioritizing assigned work

Responsibilities

• Uploading audit packets to the Central Data Abstraction Tool (CDAT) for CMS RADV.
• Handling administrative claims review.
• Conducting claims review/investigation.
• Collaborating with the retrieval team and other internal groups.
• Analyzing data uploaded to CMS.
• Reviewing audit packets.
• Verifying member data matches prior to upload.

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term disability
• Long-term disability
• Life insurance

What This Job Offers

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