Humana Inc. is committed to putting health first, and they are seeking a Risk Adjustment Representative to conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes. The role involves ensuring coding accuracy, analyzing medical records, and participating in provider education programs on coding compliance.
Responsibilities
- Conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies
- Perform varied activities and moderately complex administrative/operational/customer support assignments
- Ensure coding is accurate and properly supported by clinical documentation within the health record
- Follow state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records
- Participate in provider education programs on coding compliance
- Make decisions focused on interpretation of area/department policy and methods for completing assignments
- Work within defined parameters to identify work expectations and quality standards, with some latitude over prioritization/timing, under minimal direction
- Follow standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion
Skills
- 1 or more years of Customer Service experience
- Experience with Medical records
- Experience with Medical terminology
- Proficiency in Microsoft Office applications: Word and Excel
- Knowledge and experience in health care environment/managed care (provider office, billing, coding, release of information, etc.)
- 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 are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher
- Must be able to travel up to 70% of the time at peak season including some overnight travel
- Must live in the St. Louis, MO area
- Demonstrated ability to articulate ideas effectively in both written and oral forms
- Organizational and time management skills
- Must be passionate about contributing to an organization focused on continuously improving consumer experience
- Familiarity with ICD-9/10 coding
Benefits
- 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
Company Overview
Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.
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