Risk Adjustment Representative

The Risk Adjustment Representative 3 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 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

The Risk Adjustment Representative 3 ensures sites with open medical records requests are contacted in order for Humana to obtain a copy of records. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

• Management of sites assigned and tracking of records received to a specified goal
• Document progress/calls made daily/complete daily productivity report
• Research site information/update information internally
• Collaboration with IPA and Medical Groups, etc...
• Adapt to changes, business purpose
• Back up to leadership with process and procedures

• High School Diploma
• 3 or more years of experience in healthcare environment/managed care (provider office, billing, coding, medical records, etc.)
• Proficiency in Microsoft Office applications:
  Word, Excel, and Power Point
• This role 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
• Strong written and verbal communication skills
• Organizational and time management skills
• Ability to travel up to 20% to provider offices within CA
• Understanding of IPA

• Medical record terminology
• Knowledge of contracting

Monday - Friday business hours (8-5pm Pacific Time Zone). Overtime as needed. Hours subject to change based on business needs.

Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.

40

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.

$43,000 - $56,200 per year

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…