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.
Use your skills to make an impact
Required Qualifications
- 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
- This job 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 and requires running a Motor Vehicle Report as part of the background check process.
- Must be agreeable to occasional travel to the Humana office in Charlotte, NC and to provider locations throughout the region to support business needs.
Preferred Qualifications
- 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
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and 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 and many other opportunities.About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Skills Required
- Minimum 6 months of medical record retrieval experience
- Experience in customer service within a healthcare setting
- Proficiency in Microsoft Office applications, including Word and Excel
- Valid state driver's license and proof of personal vehicle liability insurance (minimum 100/300/100); Motor Vehicle Report will be run
- Agreeable to occasional travel to company office in Charlotte, NC and to provider locations throughout the region
- Ability to work from a dedicated home workspace protecting PHI/HIPAA and maintain minimum internet speeds (25 Mbps download / 10 Mbps upload)
- Bachelor's Degree
- Strong written and verbal communication, analytical, organizational and time management skills
- Experience working in a managed care environment
- Knowledge of ICD-9 and ICD-10 coding systems
Humana Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Humana and has not been reviewed or approved by Humana.
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Healthcare Strength — Medical, dental, vision, supplemental health, and long-term care insurance are offered alongside on-site/virtual wellness resources and weekly paid well-being time, indicating a whole-person focus.
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Leave & Time Off Breadth — Paid PTO and holidays, volunteer time, and formal leave options such as parental and caregiver time provide broad time-away support. Adoption assistance and lactation rooms extend coverage for key life events.
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Retirement Support — A 401(k) with company match anchors long-term savings. Employer-matched emergency savings programs complement retirement planning.
Humana Insights
What We Do
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
