Remote Risk Adjustment QA Auditor & Records Specialist

Humana; United States; 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 for CMS and other agencies. The role performs advanced administrative and operational support with independent judgment, including intermediate math tasks.

Responsibilities include managing assigned sites, tracking records toward goals, and collaborating with IPA/Medical Groups. Travel up to 20% to CA may be required.

Qualifications

• High School Diploma required.
• 3+ years in healthcare environment/managed care.
• Proficiency in Word, Excel, and PowerPoint.
• Valid driver’s license and vehicle insurance (100/300/100).
• 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.

Responsibilities

• Manage sites assigned and track records received to a defined goal.
• Document progress and calls daily; complete daily productivity report.
• Research site information and update information internally.
• Collaborate with IPA and Medical Groups, etc.
• Adapt to changes and align with business purpose.
• Back up leadership with processes and procedures.

Skills

Communication skills

Organizational and time management

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 for CMS and other agencies. The role performs advanced administrative and operational support with independent judgment, including intermediate math tasks.

Responsibilities include managing assigned sites, tracking records toward goals, and collaborating with IPA/Medical Groups. Travel up to 20% to CA may be required.