Remote Risk Adjustment Auditor III

Humana; Vista (CA); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is seeking a Risk Adjustment Representative 3 to conduct quality assurance audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies. The role requires independent initiative and advanced administrative/operational support, with mathematical skills as needed.

Responsibilities include coordinating record requests with sites, monitoring progress, and collaborating with IPA and Medical Groups.

Qualifications

• 3+ years of experience in healthcare environment/managed care (provider office, billing, coding, medical records, etc.)
• Proficiency in Microsoft Office applications: Word, Excel, and PowerPoint
• Requires valid state driver’s license and proof of personal vehicle liability insurance (100/300/100)

Responsibilities

• 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

Skills

Healthcare experience

Communication skills

Time management

Travel readiness

Microsoft Office

Education

High School Diploma

Tools

Microsoft Office

Job description

Humana is seeking a Risk Adjustment Representative 3 to conduct quality assurance audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies. The role requires independent initiative and advanced administrative/operational support, with mathematical skills as needed.

Responsibilities include coordinating record requests with sites, monitoring progress, and collaborating with IPA and Medical Groups.