Risk Adjustment Representative

Humana Inc. is committed to putting health first, and they are seeking a Risk Adjustment Representative to conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes. The role involves ensuring coding accuracy, analyzing medical records, and participating in provider education programs on coding compliance.

Responsibilities

• Conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies
• Perform varied activities and moderately complex administrative/operational/customer support assignments
• Ensure coding is accurate and properly supported 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
• Make decisions focused on interpretation of area/department policy and methods for completing assignments
• Work within defined parameters to identify work expectations and quality standards, with some latitude over prioritization/timing, under minimal direction
• Follow standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion

Skills

• 1 or more years of Customer Service experience
• Experience with Medical records
• Experience with Medical terminology
• Proficiency in Microsoft Office applications: Word and Excel
• Knowledge and experience in health care environment/managed care (provider office, billing, coding, release of information, etc.)
• Must have reliable transportation
• This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher
• Must be able to travel up to 70% of the time at peak season including some overnight travel
• Must live in the St. Louis, MO area
• Demonstrated ability to articulate ideas effectively in both written and oral forms
• Organizational and time management skills
• Must be passionate about contributing to an organization focused on continuously improving consumer experience
• Familiarity with ICD-9/10 coding

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance

Company Overview