Risk Adjustment Professional

Become a part of our caring community and help us put health first

The Risk Adjustment Professional 2 conducts quality assurance audits of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies.

The Risk Adjustment Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Risk Adjustment Professional 2 plays a vital role in supporting the effective execution of Risk Adjustment initiatives and medical record retrieval activities. This position ensures that operational processes are carried out with accuracy, efficiency, and strict compliance with regulatory requirements.

• Support risk adjustment staff, processes and medical record retrieval activities in accordance with state and federal regulations, as well as internal policies and procedures.

• Review and analyze coding information and medical records to support compliance and accuracy.

• Participate in provider education programs focused on coding compliance as needed.

• Serve as a liaison between market and corporate teams, promoting clear communication and alignment of objectives.

• Collaborate with other departments to facilitate cross-functional initiatives and problem-solving.

• Make independent decisions regarding work methods, especially in ambiguous situations, while seeking guidance when appropriate.

• Consistently follow established guidelines and procedures.

Use your skills to make an impact

• Minimum of 3 years of experience in the healthcare industry

• Proven medical record retrieval experience

• Demonstrated understanding of regulatory and compliance standards related to risk adjustment

• Proficiency in Microsoft Office applications, including Word, Excel, and Power Point

• Strong professional written and verbal communication skills, with demonstrated analytical, organizational, and time management abilities

• History of effective cross-departmental collaboration

• Ability to multi-task and adapt to shifting priorities in a fast-paced environment

• Previous experience in delivering individual and team training

• Willingness and ability to travel up to 10% of the time within the specified region (Texas, Arkansas, and/or Oklahoma)

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Extensive experience working with Cotiviti

• Experience in HEDIS

• Experience with Medicare Risk Adjustment (MRA) processes

• Medical coding experience

As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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.

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…