Risk Adjustment Representative

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