Risk Adjustment Admin Professional

Become a part of our caring community.

About the role

The Risk Adjustment Administration Professional 1 is responsible for uploading packets for CMS RADV (Risk Adjustment Data Validation) to CDAT (Central Data Abstraction Tool). This role also involves administrative review, claims review/investigation, and collaboration with various teams including the retrieval team. Work assignments are often straightforward and of moderate complexity, including analysis of data uploaded to CMS, review of packets, and some claims review.

Understands own work area professional concepts, standards, regulations, strategies, and operating standards. Makes decisions regarding own work approach and priorities, and follows direction. Work is driven by CMS deadlines and is managed and guided by precedent, documented procedures, regulations, or professional standards with some interpretation.

Responsibilities

• Uploading audit packets to the Central Data Abstraction Tool (CDAT) for CMS RADV.
• Handling administrative claims review and investigation.
• Collaborating with retrieval and other internal teams.
• Conducting analysis of data uploaded to CMS.
• Reviewing packets and performing claims review.

Requirements

• 2+ years of Microsoft Excel experience.
• Software and applications navigation skills.
• Experience with cross-validation of data sets.
• Ability to verify member data matches prior to upload.

Preferred Qualifications

• CAS – claims experience reviewing and understanding.
• Deadline-driven with the ability to prioritize tasks to meet internal and external deadlines.
• Task-oriented, completing assigned work and prioritizing tasks effectively.
• Self-motivated, taking initiative and working with minimal supervision.
• Team player, assisting other team members and seeking additional work when needed.

Work at Home Requirements

• Self-provided internet service must meet the following criteria: minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable, or DSL connection is suggested.
• In certain roles, the minimum recommended internet speed may not be sufficient for business needs, and Humana reserves the right to require associates to upgrade their internet service if necessary.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled weekly hours: 40.

Pay

The pay range reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The range may vary based on geographic location and individual pay will depend on demonstrated job-related skills, knowledge, experience, education, and certifications.

$59,300 - $80,900 per year.

Benefits

Humana offers competitive benefits that support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off, including paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities for personal wellness and smart healthcare decisions.