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The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record.

• Reviews medical records to report conditions that map to HCCs by reviewing medical record documentation and applying the appropriate ICD-10 diagnosis codes.
• Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.
• Works on projects that may include making phone calls to providers.
• Works within broad guidelines with little oversight.
• Demonstrates a professional demeanor, strong work ethic, and is a reliable team player with a positive attitude.
• Utilizes effective written and verbal communication skills.
• Demonstrates Proficiency in using computers and relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools.
• Participates on special projects, in addition to daily responsibilities.
• Associates may be required to work mandatory overtime to meet business needs and ensure timely completion of operational tasks.

Work hours:

Training for the first 3 weeks will be Mon-Fri 8am- 4:30pm Eastern time in a virtual/remote classroom.

After training, you will work a 40 hour shift Mon-Fri, within your own time zone. There will be occasional overtime to support business needs

Use your skills to make an impact
 

Required Qualifications

At least one of the certifications from AAPC or AHIMA are required from the list below:

• CPC or CPC-A - Certified Professional Coder (AAPC)
• COC - Certified Outpatient Coder (AAPC)
• CIC - Certified Inpatient Coder (AAPC)
• CRC - Certified Risk Coder (AAPC)
• CCA - Certified Coding Associate (AHIMA)
• CCS - Certified Coding Specialist (AHIMA)
• CCS-P - Certified Coding Specialist-Physician Based (AHIMA)

• Experience working in a goal-oriented environment that is production and quality driven.
• Must maintain annual continuing education requirements and remain in good standing with the coding credentialing body, AAPC or AHIMA.
• Must be able to attend a 3 week virtual classroom training, Monday-Friday 8am- 4:30pm Eastern time
• Must be able to work 40 hours a week, Monday – Friday, with the ability to work mandatory overtime as needed to support business needs.
• Must have a confidential work space in order to work effectively and independently without distractions.
• Proficient using relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools.

Preferred Qualifications

• Proficient in the use of Microsoft Office systems Word and Excel
• Risk Adjustment Experience
• HCC Coding experience

Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. 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.

 

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.

 

$48,300 - $65,900 per year

 

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive ben