The Risk Adjustment Coder performs quality assurance coding of medical records and ICD-10 diagnosis codes submitted to CMS and other government agencies. This role ensures coding accuracy and that diagnoses are properly supported by clinical documentation in the health record.
Responsibilities include reviewing medical records to identify conditions that map to HCCs, applying appropriate ICD-10 diagnosis codes, following state and federal regulations and internal guidelines, supporting provider outreach as needed, and contributing to special projects. The position requires independent judgment, strong communication skills, and comfort working with multiple software applications and digital tools.
Training is conducted virtually for the first 3 weeks, Monday through Friday from 8:00 AM to 4:30 PM Eastern Time. After training, the role is a 40-hour workweek, Monday through Friday, within the employee's own time zone, with occasional overtime as business needs require. Occasional travel to Humana offices for training or meetings may be required.
Required Qualifications
- One of the following certifications is required:
- CPC or CPC-A (AAPC)
- COC (AAPC)
- CIC (AAPC)
- CRC (AAPC)
- CCA (AHIMA)
- CCS (AHIMA)
- CCS-P (AHIMA)
- Experience in a goal-oriented environment that is production and quality driven
- Maintain annual continuing education requirements and remain in good standing with AAPC or AHIMA
- Ability to attend 3 weeks of virtual classroom training, Monday through Friday, 8:00 AM to 4:30 PM Eastern Time
- Ability to work 40 hours per week Monday through Friday, with mandatory overtime as needed
- Dedicated, confidential workspace free from distractions
- Proficiency with computers, multiple software applications, and digital tools
Preferred Qualifications
- Proficiency with Microsoft Word and Excel
- Risk adjustment experience
- HCC coding experience
Work from Home Requirements
- Minimum internet speed of 25 Mbps download and 10 Mbps upload
- A dedicated space with no ongoing interruptions to protect PHI/HIPAA information
Humana offers competitive benefits including:
- Medical, dental, and vision coverage
- 401(k) retirement savings plan
- Paid time off, company holidays, and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability coverage
- Life insurance
Location
Wisconsin, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$48,300 - $65,900
Remote work allowed
Yes
Posted
1 week ago