Remote Risk Adjustment QA Auditor III

Humana; New Mexico; Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is seeking a Risk Adjustment Representative 3 to conduct QA audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies. This role requires independent initiative and judgment and may apply intermediate mathematical skills.

Responsibilities include ensuring sites with open medical records requests are contacted to obtain copies, tracking progress, and documenting daily productivity. Travel up to 20% to provider offices.

Qualifications

• High School Diploma required.
• 3+ years in healthcare/managed care environment.
• Proficiency with MS Word, Excel, PowerPoint.
• Valid driver's license and vehicle liability insurance.
• Strong written and verbal communication skills.
• Ability to travel up to 20% to provider offices in CA.
• Knowledge of IPA helpful.

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

MS Office

Communication

Education

High School Diploma

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Humana is seeking a Risk Adjustment Representative 3 to conduct QA audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies. This role requires independent initiative and judgment and may apply intermediate mathematical skills.

Responsibilities include ensuring sites with open medical records requests are contacted to obtain copies, tracking progress, and documenting daily productivity. Travel up to 20% to provider offices.