Senior Risk Adjustment Professional

Profile

Description

The Senior Risk Adjustment Professional manages multiple projects and 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. The Senior Risk Adjustment Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Risk Adjustment Professional manages projects and initiatives to ensure 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. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Bachelor's degree

Proficiency in all Microsoft Office Programs including Word, PowerPoint, Excel, Access, etc.

Proficiency in data analytics--using Microsoft Excel, Power BI, and/or other applications

Strong written and verbal communication skills; strong analytical, organizational and time management skills

Experience working in health service industry

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Master's Degree in Business Administration or a related field

Knowledge of SQL

Project management experience

Knowledge of ICD-10 coding

Additional Information

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com