Risk Adjustment Representative

🔥 44 minutes ago

🏄 California, Hawaii, +2 more states – Remote

🏄 California – Remote 🌺 Hawaii – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote

💵 $43k - $56.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies • Contact sites with open medical records requests to obtain copies of records • Manage assigned sites and track records received to a specified goal • Document progress and calls made daily and complete daily productivity reports • Research site information and update information internally • Collaborate with IPAs and Medical Groups • Adapt to changes and business purpose • Back up leadership with process and procedures • Exercise independent initiative, judgment, discretion, and prioritization when completing administrative and operational tasks • Travel occasionally to provider offices and potentially Humana offices for training or meetings

🎯 Requirements

• 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 PowerPoint • Valid state driver's license • 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 (preferred) • Knowledge of contracting (preferred) • Ability to work Monday-Friday business hours, 8-5pm Pacific Time Zone • Ability to work overtime as needed • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Minimum home internet speed of 25 Mbps download and 10 Mbps upload

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Flexible remote work arrangement • Internet service requirements/support for home or hybrid employees

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