Humana · 6 hours ago
Risk Adjustment Professional 2
United States
Full-time
Remote
Mid Level
$65K/yr - $89K/yr
3+ years expHumana is committed to putting health first, and they are seeking a Risk Adjustment Professional 2 to conduct quality assurance audits of medical records and ICD-10 diagnosis codes. This role supports the execution of Risk Adjustment initiatives and ensures compliance with regulatory requirements.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Support risk adjustment staff, processes and medical record retrieval activities in accordance with state and federal regulations, as well as internal policies and procedures
Review and analyze coding information and medical records to support compliance and accuracy
Participate in provider education programs focused on coding compliance as needed
Serve as a liaison between market and corporate teams, promoting clear communication and alignment of objectives
Collaborate with other departments to facilitate cross-functional initiatives and problem-solving
Make independent decisions regarding work methods, especially in ambiguous situations, while seeking guidance when appropriate
Consistently follow established guidelines and procedures
Qualification
Required
Minimum of 3 years of experience in the healthcare industry
Proven medical record retrieval experience
Demonstrated understanding of regulatory and compliance standards related to risk adjustment
Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint
Strong professional written and verbal communication skills, with demonstrated analytical, organizational, and time management abilities
History of effective cross-departmental collaboration
Ability to multi-task and adapt to shifting priorities in a fast-paced environment
Previous experience in delivering individual and team training
Willingness and ability to travel up to 10% of the time within the specified region (Texas, Arkansas, and/or Oklahoma)
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Extensive experience working with Cotiviti
Experience in HEDIS
Experience with Medicare Risk Adjustment (MRA) processes
Medical coding experience
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
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
Caleb Gallifant
Vice President Of Product
Recent News
2026-01-16
2026-01-16
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