Risk Adjustment Representative

Humana

3d • $40,000 - $52,300 • Remote

About The Position

Become a part of our caring community and help us put health first 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 Risk Adjustment Representative 2 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. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. Use your skills to make an impact

Requirements

• 1 or more years of Customer Service experience
• Experience with Medical records
• Experience with Medical terminology
• Proficiency in Microsoft Office applications: Word and Excel
• Knowledge and experience in health care environment/managed care (provider office, billing, coding, release of information, etc.)
• Must have reliable transportation
• This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual 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.
• Must be able to travel up to 70% of the time at peak season including some overnight travel
• Must live in the St. Louis, MO area
• Demonstrated ability to articulate ideas effectively in both written and oral forms
• Organizational and time management skills
• Must be passionate about contributing to an organization focused on continuously improving consumer experience

Nice To Haves

• Familiarity with ICD-9/10 coding
• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Responsibilities

• Conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes
• Performs varied activities and moderately complex administrative/operational/customer support 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

• Humana provides 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 and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees