Remote Risk Adjustment QA Auditor III

Humana; California (MO); Remote; USD 43.000 - 56.000; Vollzeit

Zusammenfassung

Humana seeks a Risk Adjustment Representative 3 to conduct QA audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies. The role requires independent judgment, supports administrative tasks, and may use intermediate mathematical skills. Travel up to 20% to CA provider offices is required.

Responsibilities include managing sites, tracking records, and collaborating with IPA/Medical Groups. This is a remote position with standard M-F hours and top-tier benefits.

Qualifikationen

• High school diploma required; 3+ years in healthcare/managed care environment.
• Proficiency with Microsoft Word, Excel and PowerPoint.
• Valid state driver’s license with personal vehicle liability insurance (100/300/100).
• Willingness to travel up to 20% to provider offices in CA.
• Strong written and verbal communication; good organizational skills.

Aufgaben

• Manage assigned sites and track records to meet goals.
• Document daily progress and complete productivity reports.
• Research site information and update records internally.
• Collaborate with IPA and Medical Groups.
• Adapt to changing processes and provide leadership backups.

Kenntnisse

Written communication

Verbal communication

Time management

Organizational skills

IPA knowledge

Travel readiness

Microsoft Office

Ausbildung

High School Diploma

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Jobbeschreibung

Humana seeks a Risk Adjustment Representative 3 to conduct QA audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies. The role requires independent judgment, supports administrative tasks, and may use intermediate mathematical skills. Travel up to 20% to CA provider offices is required.

Responsibilities include managing sites, tracking records, and collaborating with IPA/Medical Groups. This is a remote position with standard M-F hours and top-tier benefits.