Humana · 23 hours ago
Risk Adjustment Representative
United States
Full-time
Remote
Entry Level
$40K/yr - $52K/yr
1+ years expHumana is committed to putting health first and is seeking a Risk Adjustment Representative to join their team. The role involves conducting quality assurance audits of medical records and ensuring coding accuracy while adhering to regulations and internal policies.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
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
Performs varied activities and moderately complex administrative/operational/customer support assignments
Performs computations
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
Makes decisions that typically focus on interpretation of area/department policy and methods for completing assignments
Works within defined parameters to identify work expectations and quality standards
Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion
Qualification
Required
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
Preferred
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
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-07
2026-01-06
2026-01-04
Company data provided by crunchbase