About Humana


Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations


United States

Approximate Salary:

Not Specified

Position Type:

Full time

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Risk Adjustment Representative 2- Syracuse, NY or Portland, ME (Record Retrieval)

Humana - Work At Home, New York

Posted: 09/1/2018


The Risk Adjustment Representative 2 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 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.


The Risk Adjustment Representative 2 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. May participate in provider education programs on coding compliance. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.


Required Qualifications

  • High School Diploma or equivalent
  • Less than 3 years of technical experience
  • Proficiency in all Microsoft Office applications, including Word and Excel
  • 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

  • Bachelor's Degree
  • Strong written and verbal communication skills; strong analytical, organizational and time management skills
  • Knowledge and experience in health care environment/managed care
  • Strong knowledge of ICD-9/10 codes

Additional Information

Scheduled Weekly Hours


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