Become a part of our caring community and help us put health first
 

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 Record Retrieval Representative (Risk Adjustment Representative):

• Travel up to 50% of the time in Orange, Osceola and other surrounding counties in FL with the possibility of occasional overnight

• Travel up to a week at time to surrounding counties near Jacksonville, based on business needs

• Collect medical records by using a laptop and portable scanner to scan paper records and/or download electronic medical records to a thumb drive to meet production goals

• Visits to physician offices in a timely, efficient manner to meet all deadlines

• Answering phones, electronically faxing, internet search and email utilization

• Research and updates site information by utilizing CarePlus internal systems

• Follows CarePlus and HIPAA confidentiality standards to protect the confidentiality of member information

• Demonstrates a professional and courteous manner when communicating with others with the ability to clearly and accurately state the agreed upon resolution

Use your skills to make an impact
 

Required Qualifications

• Live in the Orlando Florida area

• 1 or more years of Telephonic environment experience and/or customer service in an office setting

• Proficiency in Microsoft Office Word and Excel

• Ability to travel locally up to 50% of the time

• Ability to travel overnight occasionally within the region

• Must have reliable car transportation

• Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems

• This job 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 and requires running a Motor Vehicle Report as part of the background check process.

Preferred Qualifications

• 1 or more years of experience with Medical Record or Health information retrieval experience In a Hospital, Healthcare and/or Medical Office setting

• Knowledge and experience in managed care

• Medical terminology

• Experience in EMR (Electronic Medical Records) system 

• Medical Record retrieval experience

• Bilingual English and Spanish

• Healthcare experience

Additional Information

• Hours 8am-5pm, could be earlier depending on travel/provider office. Hours subject to change based on business needs

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illi