Remote Risk Adjustment Specialist III

Humana; California; 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. This role requires independent initiative and judgment and may involve intermediate mathematical tasks.

The position supports sites with open medical records requests, coordinating with IPA and Medical Groups, and prioritizing administrative tasks while adhering to Humana processes.

Qualifications

• High School Diploma required.
• 3+ years in healthcare environment/managed care (provider office, billing, coding, medical records).
• Proficiency in Word, Excel, and PowerPoint.

Responsibilities

• Manage sites assigned and track records received to a specified goal.
• Document progress/calls daily and complete daily productivity report.
• Research site information and update information internally.

Skills

Communication skills

Time management

Organizational skills

Travel ability

IPA knowledge

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. This role requires independent initiative and judgment and may involve intermediate mathematical tasks.

The position supports sites with open medical records requests, coordinating with IPA and Medical Groups, and prioritizing administrative tasks while adhering to Humana processes.