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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 Medical Records Retrieval Specialist performs moderately complex administrative and operational tasks in a remote and field based, structured environment, with a focus on accuracy, compliance, and efficiency.
Job Description
- Travel up to 50% to 75% of the time and will consist of driving to locations close to your home, as well as driving to locations that require overnight travel for up to a week at a time.
- Use a laptop computer and a portable scanner to retrieve medical records which will be uploaded into a database.
- Schedule appointments and visits to physician offices in a timely, efficient manner to meet all deadlines.
- 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.
Duties and Responsibilities
- Collect medical records to ensure accuracy of member information and obtain provider signatures.
- Upload verified documents to Cotiviti centralized repository.
- Follow state and federal regulations as well as internal policies and guidelines while retrieving medical records.
- Interpret and apply departmental procedures to complete assignments with accuracy and efficiency.
- Use a laptop computer and a portable scanner and encrypted flash drive to retrieve medical records which will be uploaded into a database.
- Communicate with physician offices by phone and email to efficiently meet all deadlines.
- Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines.
- Independently manage workload within defined service level expectations.
Use your skills to make an impact
Required Qualifications
- High School Diploma
- Professional appearance and attitude
- Must have reliable transportation
- Demonstrated organizational skills
- At least 3 years of technical experience
- Proficiency in all Microsoft Office applications, including Word and Excel
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
- Excellent communication skills, both verbal and written
- Ability to travel locally 50% to 75% of the time. Candidate to reside within Raleigh, Fayette, Greenbrier, Nicholas, Clay, Summers, Monroe, or Mercer counties in WV.
- Ability to travel overnight occasionally
- 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
- Associate's Degree
- Strong written and verbal communication skills; strong analytical, organizational and time management skills
- Minimum 1 year knowledge and experience in health care environment/managed care
- Knowledge of ICD-9/10 codes
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay 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.
$40,000 - $52,300 per year
Description 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.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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.