Risk Adjustment Coder

Humana; Town of Texas (WI); Remote; USD 48,000 - 66,000; Full time

Job summary

Join a leading healthcare company as a Risk Adjustment Coder, where you will ensure accurate coding of medical records and support quality improvement initiatives. This remote role emphasizes the importance of detail-oriented work and requires certification from AAPC or AHIMA. Enjoy the flexibility of remote work while making an impact on healthcare quality standards.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance benefits

Qualifications

• Must hold certification from AAPC or AHIMA.
• Able to maintain continuing education requirements.
• Experience in Risk Adjustment and medical coding preferred.

Responsibilities

• Conduct quality assurance coding of medical records.
• Ensure diagnosis codes are compliant and accurate.
• Support Corporate Coding Operations within HQRI department.

Skills

Attention to detail

Effective communication

Teamwork

Technical aptitude

Education

AAPC or AHIMA certification

Tools

Microsoft Office (Word, Excel)

Job description

Become a part of our caring community and help us put health first

The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Risk Adjustment Coder will support our Corporate Coding Operations within the Healthcare Quality Reporting & Improvement (HQRI) department of Humana.

The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record.

• Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.
• Works projects that may include making phone calls to providers.
• Works within broad guidelines with little oversight.
• Implement a professional demeanor, strong work ethic, reliable, resourceful, enthusiastic team player, positive attitude.
• Utilize effective written and verbal communication skills.
• Apply working knowledge of computers, and a demonstrated technical aptitude and an ability to quickly learn new systems.
• Will participate on special projects, in addition to daily responsibilities, that may involve overtime.
  
  

Required Qualifications

Use your skills to make an impact

At least ONE of the certifications from AAPC or AHIMA are required from the list below:

• CPC - Certified Professional Coder (AAPC).
• CPC-A Certified Professional Coder Apprenticeship (AAPC).
• COC - Certified Outpatient Coder (AAPC).
• CIC - Certified Inpatient Coder (AAPC).
• CRC - Certified Risk Coder (AAPC).
• CCA - Certified Coding Associate (AHIMA).
• CCS - Certified Coding Specialist (AHIMA).
• CCS-P - Certified Coding Specialist-Physician Based (AHIMA).
  
  

Must maintain annual continuing education requirements and remain in good standing with the certification governing body.

• Must be able to work in a goal-oriented environment that is production and quality driven.
• Must be able to work 40 hours a week, 8-hour shifts, Monday – Friday, with ability to work overtime as needed to support the business.
• Must be able to work within the hours of 8 a.m.- 4:30 p.m. EST for the first 3 weeks of virtual classroom training.
• Must be able to work effectively and independently without distractions.
• Must have good working knowledge of computers, and a demonstrated technical aptitude and an ability to quickly learn new systems.
  
  

Preferred Qualifications

• Risk Adjustment Experience.
• Coding Experience.
• Proficient in the use of Microsoft Office systems Word and Excel.
  
  

Additional Information

• Training: 3 weeks of Virtual Classroom training between the hours of 8:00 A.M. – 4:30 P.M. Eastern Standard Time (EST) with no time off during these first 3 weeks of training. This will be followed by an additional 8-12 weeks of mentoring/ongoing training. The training is scheduled for September 8th, 2025.
• Work Days/Hours: After Training, the expectation is to work Monday – Friday and you must be able to work an 8 hour shift for 40 hours a week.
  
  

Work Style: Remote

Work At Home/Remote Requirements

To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
  

HireVue Statement: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$48,300 - $65,900 per year

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 07-18-2025

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.