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Risk Adjustment Representative at Humana Inc.

Risk Adjustment Representative

Humana Inc. Lutz, FL (Onsite) Full-Time

The Risk Adjustment Representative conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Representative performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.


This position is considered remote work at home Florida and must reside within Hillsborough County. Must be able to travel up to 50% of the time in Hillsborough and surrounding counties with possibility of occasional overnight travel.

* Travels up to 50% of the time to provider offices and/or healthcare facilities within the outlined region
* Collect medical records by using a laptop and portable scanner to scan paper records and/or download electronic medical records to a thumb drive
* Upload collected medical records to CarePlus' system appropriately and in a timely manner
* Demonstrates a professional and courteous manner when communicating with others with the ability to state clearly and accurately the agreed upon resolution
* Perform a variety of administrative duties including but not limited to:
* answering phones, electronically faxing, completing documents, internet search and email utilization
* Schedule and confirm appointments
* Research and updates site information by utilizing CarePlus' internal systems

* Meet daily production goal requirement
* Performs other related duties and projects as assigned within the assigned timeframes
* Adhere to CarePlus Policies and Procedures, process standards, and Standard Operating Procedures
* Complies with CarePlus and HIPAA confidentiality standards to protect the confidentiality of member information
* Consult leadership, team members and appropriate resources to solve issues
* Provide feedback to leadership in a timely manner
* Provide excellent customer service to all internal and external business partners

Required Qualifications

* Knowledge and skill in the use of scanner, fax, and electronic health record technology

* Working knowledge of computers in general and an ability to quickly learn new systems

* Proven experience in a fast paced administrative or technical support role

* Proficiency in Microsoft Office Word, Excel, and Outlook

* Professional appearance always

* Excellent communication skills, both verbal and written

* Exceptional organization skills, strong attention to detail

* Must be able to walk short distances and transport equipment to retrieve medical records.

* Must have reliable transportation

* This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits

Preferred Qualifications

* Proficient utilizing electronic medical record and documentation programs

* Associate's or Bachelor's Degree in a related field

* Previous healthcare or health insurance experience

* Familiarity with medical terminology and/or ICD-10 codes

Additional Information

Humana Perks:

Full time associates enjoy:

* Medical, Dental, Vision and a variety of?other?supplemental insurances

* Paid time off?(PTO)?& Paid Holidays

* 401(k) retirement savings plan

* Tuition?reimbursement and/or scholarships for qualifying dependent children.

* And much more!

Social Security Task:

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [ Email address blocked ] - Click here to apply to Risk Adjustment Representative with instructions to add the information into the application at Humana's secure website.

Virtual Pre-Screen:

As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a Modern Hire interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.

Work-At-Home Requirements

* WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

* A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

* Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information #LI-Remote

Scheduled Weekly Hours


Recommended Skills

  • Administration
  • Attention To Detail
  • Auditing
  • Communication
  • Confidentiality
  • Content Management
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Job ID: 2467714435

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