[Hiring] Risk Adjustment Professional 2 @Humana

Role Description

The Risk Adjustment Professional 2 conducts quality assurance audits of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. This position ensures that operational processes are carried out with accuracy, efficiency, and strict compliance with regulatory requirements.

• Support risk adjustment staff, processes and medical record retrieval activities in accordance with state and federal regulations, as well as internal policies and procedures.
• Review and analyze coding information and medical records to support compliance and accuracy.
• Participate in provider education programs focused on coding compliance as needed.
• Serve as a liaison between market and corporate teams, promoting clear communication and alignment of objectives.
• Collaborate with other departments to facilitate cross-functional initiatives and problem-solving.
• Make independent decisions regarding work methods, especially in ambiguous situations, while seeking guidance when appropriate.
• Consistently follow established guidelines and procedures.

Qualifications

• Minimum of 3 years of experience in the healthcare industry
• Proven medical record retrieval experience
• Demonstrated understanding of regulatory and compliance standards related to risk adjustment
• Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint
• Strong professional written and verbal communication skills, with demonstrated analytical, organizational, and time management abilities
• History of effective cross-departmental collaboration
• Ability to multi-task and adapt to shifting priorities in a fast-paced environment
• Previous experience in delivering individual and team training
• Willingness and ability to travel up to 10% of the time within the specified region (Texas, Arkansas, and/or Oklahoma)
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Extensive experience working with Cotiviti
• Experience in HEDIS
• Experience with Medicare Risk Adjustment (MRA) processes
• Medical coding experience

Work-At-Home Requirements

• 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 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

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.

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

• Humana, Inc. and its affiliated subsidiaries offer 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.
• 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.

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.