Humana Employment – Risk Adjustment Representative

Job Description:

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.

Job Responsibilities:

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.

Job Requirements:

• Strong knowledge of ICD-9/10 codes
• Strong written and verbal communication skills; strong analytical, organizational and time management skills
• 3+ years of experience working as a medical records retrieval specialist, in a provider office or healthcare administration, or copy service company
• CPC (Certified Professional Coder) Certification required
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Proficiency in all Microsoft Office applications, including Word and Excel
• Knowledge and experience in health care environment/managed care
• Bachelor’s Degree
• Valid Drivers License and reliable transportation

Job Details:

Company:  Humana

Vacancy Type:  Full Time

Job Location: Charlotte, NC, US

Application Deadline: N/A

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