Remote Risk Adjustment Specialist III

Humana; Nevada; Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is seeking a Risk Adjustment Representative 3 to perform QA audits of medical records and ICD-9/10 codes for CMS and other government programs. The role requires independent initiative and strong administrative judgment across complex processes.

You will contact sites with open records requests, prioritize tasks, and collaborate with IPA and Medical Groups. Remote work is possible with occasional travel to CA; must be proficient in MS Office and able to support HIPAA information

Qualifications

• 3+ years in healthcare/managed care environment (provider office, billing, coding, med records).
• Valid state driver’s license and personal vehicle liability insurance (100/300/100).
• Willingness to travel up to 20% to CA provider offices.
• Strong written and verbal communication skills.
• Organizational and time management skills.

Responsibilities

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

Skills

Strong written and verbal comms

Organizational and time management

MS Office proficiency (Word, Excel, PP

Education

High School Diploma

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Humana is seeking a Risk Adjustment Representative 3 to perform QA audits of medical records and ICD-9/10 codes for CMS and other government programs. The role requires independent initiative and strong administrative judgment across complex processes.

You will contact sites with open records requests, prioritize tasks, and collaborate with IPA and Medical Groups. Remote work is possible with occasional travel to CA; must be proficient in MS Office and able to support HIPAA information