Risk Adjustment Representative

Humana • Work at Home - North Carolina, NC

22h • $40,000 - $52,300 • 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. You will perform varied activities and moderately complex administrative/operational/customer support assignments, performs computations and works on semi-routine assignments. The Risk Adjustment Representative 2 ensures coding is accurate and properly supported by clinical documentation within the health record. You will follow state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. You may participate in provider education programs on coding compliance. This position will be based from a home office with occasional travel to the office in Charlotte, NC for training and as needed for team meetings. There will also be occasional travel to retrieve records from provider locations throughout the counties of Bertie, Camden, Chowan, Currituck, Dare, Gates, Halifax, Hertford, Martin, Pasquotank, Perquimans, Tyrrell, Washington.

Requirements

• Minimum 6 months of medical record retrieval experience
• Experience in customer service within a healthcare setting
• Proficiency in all Microsoft Office applications, including Word and Excel
• Must have valid driver license and automobile insurance along with reliable transportation.
• Must be agreeable to occasional travel to the Humana office in Charlotte, NC and to provider locations throughout the region to support business needs.
• Self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; 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

• Bachelor's Degree
• Strong written and verbal communication skills
• Strong analytical, organizational and time management skills
• Experience working in a managed care environment
• Knowledge of ICD-9/10 codes

Responsibilities

• Conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies.
• Performs varied activities and moderately complex administrative/operational/customer support assignments.
• Performs computations and works on semi-routine assignments.
• Ensures coding is accurate and properly supported by clinical documentation within the health record.
• Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.
• May participate in provider education programs on coding compliance.

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