Risk Adjustment Representative

Job Overview

Become a part of our caring community. 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. This position is based from a home office with occasional travel to the Humana office in Charlotte, NC and to provider locations across the region for training and meetings.

• Conduct quality assurance audits of medical records and ICD‑9/10 diagnosis codes submitted to CMS and other agencies.
• Ensure coding accuracy and proper support by clinical documentation within the health record.
• Follow state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.
• Participate in provider education programs on coding compliance.
• Perform varied administrative, operational, and customer support assignments and computations on semi‑routine tasks.
• Travel occasionally to the Humana office in Charlotte, NC and to provider sites throughout the counties of Bertie, Camden, Chowan, Currituck, Dare, Gates, Halifax, Hertford, Martin, Pasquotank, Perquimans, Tyrrell, and Washington.

• 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 limits), and willingness to run a Motor Vehicle Report as part of the background check.
• Agreeable to occasional travel to the Humana office in Charlotte, NC and to provider locations throughout the region.

• 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.
• Ability to work from home.

Employees must provide reliable internet service meeting a minimum download speed of 25

Mbps and an upload speed of 10

Mbps. A stable wireless, wired cable, or DSL connection is recommended. Humana may require upgrades if necessary. Employees must work from a dedicated space free of interruptions to maintain PHI/HIPAA confidentiality.

Although this is a remote position, occasional travel to Humana offices for training or meetings may be required.

40 hours per week.

$40,000 – $52,300 per year.

Humana offers competitive benefits including medical, dental, and vision coverage; a 401(k) retirement savings plan; paid time off, company and personal holidays, parental and caregiver leave; short‑term and long‑term disability; and life insurance.

Humana is an equal‑opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Humana also takes affirmative action and bases all employment decisions only on valid job requirements.