Risk Adjustment Representative 2

Humana

3d • Remote

About The Position

The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Medical Records Retrieval Specialist performs moderately complex administrative and operational tasks in a remote and field based, structured environment, with a focus on accuracy, compliance, and efficiency.

Requirements

• High School Diploma
• Professional appearance and attitude
• Must have reliable transportation
• Demonstrated organizational skills
• At least 3 years of technical experience
• Proficiency in all Microsoft Office applications, including Word and Excel
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
• Excellent communication skills, both verbal and written
• Ability to travel locally 50% to 75% of the time. Candidate to reside within Raleigh, Fayette, Greenbrier, Nicholas, Clay, Summers, Monroe, or Mercer counties in WV.
• Ability to travel overnight occasionally
• This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits

Nice To Haves

• Associate's Degree
• Strong written and verbal communication skills; strong analytical, organizational and time management skills
• Minimum 1 year knowledge and experience in health care environment/managed care
• Knowledge of ICD-9/10 codes

Responsibilities

• Collect medical records to ensure accuracy of member information and obtain provider signatures.
• Upload verified documents to Cotiviti centralized repository.
• Follow state and federal regulations as well as internal policies and guidelines while retrieving medical records.
• Interpret and apply departmental procedures to complete assignments with accuracy and efficiency.
• Use a laptop computer and a portable scanner and encrypted flash drive to retrieve medical records which will be uploaded into a database.
• Communicate with physician offices by phone and email to efficiently meet all deadlines.
• Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines.
• Independently manage workload within defined service level expectations.

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
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees