Remote Risk Adjustment Specialist III

Humana, Inc.; Vista (CA); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana, Inc. is seeking a Risk Adjustment Representative 3 for a remote position with occasional travel to California. You will conduct quality assurance audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies, performing advanced administrative tasks with independence.

Responsibilities include managing sites, tracking records, and collaborating with IPA/Medical Groups. Requires healthcare experience, strong MS Office skills, and travel capability up to 20% in

Qualifications

• High School Diploma.
• 3+ years of experience in healthcare environment/managed care (provider office, billing, coding, medical records, etc.).
• Proficiency in Microsoft Office applications: Word, Excel, and PowerPoint.
• This role requires a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
• 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

• 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

Written communication

Verbal communication

Organizational skills

Time management

Travel readiness

Education

High School Diploma

Tools

Microsoft Office

Job description

Humana, Inc. is seeking a Risk Adjustment Representative 3 for a remote position with occasional travel to California. You will conduct quality assurance audits of medical records and ICD-9/10 codes submitted to CMS and other government agencies, performing advanced administrative tasks with independence.

Responsibilities include managing sites, tracking records, and collaborating with IPA/Medical Groups. Requires healthcare experience, strong MS Office skills, and travel capability up to 20% in