Risk Adjustment Representative

This is a fully remote position, open to applicants in California, +3 more states.

📋 Description

• Perform quality assurance audits on medical records and ICD-9/10 diagnosis codes submitted to CMS and various governmental bodies.

• Reach out to sites with pending medical records requests to secure copies of those records.

• Oversee assigned sites and monitor the receipt of records to meet a designated target.

• Record daily progress and calls made, and finalize daily productivity reports.

• Conduct research on site information and update it internally.

• Collaborate with Independent Practice Associations (IPAs) and Medical Groups.

• Adjust to changes and align with business objectives.

• Provide support to leadership in processes and procedures.

• Utilize independent initiative, judgment, discretion, and prioritization when executing administrative and operational responsibilities.

• Occasionally travel to provider offices and possibly Humana offices for training or meetings.

⛳️ Requirements

• High School Diploma.

• A minimum of 3 years' experience in a healthcare setting/managed care (provider office, billing, coding, medical records, etc.).

• Proficient in Microsoft Office applications: Word, Excel, and PowerPoint.

• Valid driver's license from the state.

• Evidence of personal vehicle liability insurance with a minimum coverage of 100/300/100.

• Strong written and verbal communication abilities.

• Excellent organizational and time management skills.

• Willingness to travel up to 20% to provider offices within California.

• Familiarity with Independent Practice Associations (IPA).

• Knowledge of medical record terminology (preferred).

• Understanding of contracting (preferred).

• Availability to work Monday through Friday during business hours, 8 AM to 5 PM Pacific Time Zone.

• Flexibility to work overtime as required.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload.

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Flexible remote work arrangements.

• Internet service requirements/support for home or hybrid employees.