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The Risk Adjustment Coding Professional 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 Coding Professional work assignments are often straightforward and of moderate complexity.The Risk Adjustment Coding Professional 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. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Use your skills to make an impact
Required Qualifications
- Certified Coder Certification - CPC, CCS or CCA.
- 3 years of related coding and Risk Adjustment experience.
- Proficiency in all Microsoft Office Programs including Word, PowerPoint, Excel, Access, etc.
- Demonstrated ability to balance multiple high priority tasks and meet internal and external deadlines.
- Strong collaboration and relationship building skills.
Preferred Qualifications
- Prior audit experience
- Strong analytical, organizational and time management skills
- Strong knowledge of ICD-10 coding/managed care
Additional Information
Mandatory overtime may be required.
- Hours: Must be willing to work an 8-hour shift, Monday - Friday. Start time can be on the hour or half hour between 6:00AM and 8:30AM Eastern Standard Time.
- Travel: May be authorized travel to attend Coding conference and or team building event, but not more than 5%.
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 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
Scheduled Weekly Hours
40Pay 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.$53,700 - $72,600 per yearDescription 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: 07-03-2025
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.
