The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. This role ensures coding is accurate and properly supported by clinical documentation within the health record.
The position involves reviewing medical records to identify conditions that map to HCCs, applying appropriate ICD-10 diagnosis codes, following state and federal regulations, and supporting special projects as needed. The role requires independent judgment, strong communication skills, and the ability to work within broad guidelines with limited oversight.
At least one of the following certifications is required:
- 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)
Additional requirements:
- Experience working in a goal-oriented, production- and quality-driven environment
- Must maintain annual continuing education requirements and remain in good standing with the credentialing body
- Ability to attend a 3-week virtual classroom training, Monday-Friday, 8:00 AM to 4:30 PM Eastern Time
- Ability to work 40 hours per week, Monday-Friday, with mandatory overtime as needed
- Must have a confidential work space free from distractions
- Proficiency with relevant technology and multiple software applications
Preferred qualifications:
- Microsoft Word and Excel proficiency
- Risk adjustment experience
- HCC coding experience
Humana offers benefits including:
- Medical, dental, and vision coverage
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Other wellness and family support benefits
Location
Rhode Island, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$48,300 - $65,900
Remote work allowed
Yes
Posted
1 week ago