Risk Adjustment Coding Professional 1

About the role

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 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.

Responsibilities

• Conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies
• Ensure coding is accurate and properly supported by clinical documentation within the health record
• Analyze coding information and medical records following state and federal regulations and internal policies
• May participate in provider education programs on coding compliance

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

Schedule

• Mandatory overtime may be required
• 8-hour shift, Monday – Friday
• Start time can be on the hour or half hour between 6:00AM and 8:30AM Eastern Standard Time

Pay

$53,700 - $72,600 per year

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance

Additional Information

• Travel: May be authorized travel to attend Coding conference and/or team building event, but not more than 5%; occasional travel to Humana's offices for training or meetings may be required
• Work-At-Home Requirements: High-speed DSL or cable modem required; minimum speed of 25x10 (25mbps download x 10mbps upload); satellite and wireless internet not allowed; dedicated space lacking ongoing interruptions to protect PHI/HIPAA information; California associates provided payment for internet expense
• Interview Format: Selected candidates will participate in a pre-recorded Voice Interview and/or SMS Text Messaging interview via HireVue, approximately 10-15 minutes