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About the role
The Risk Adjustment Representative 3 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 Risk Adjustment Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- High School Diploma
- 3 or more years of experience in healthcare environment/managed care (provider office, billing, coding, medical records, etc.)
- Proficiency in Microsoft Office applications: Word, Excel, and PowerPoint
- This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Strong written and verbal communication skills
- Organizational and time management skills
More about this role
The Risk Adjustment Representative 3 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 Risk Adjustment Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
The Risk Adjustment Representative 3 ensures sites with open medical records requests are contacted in order for Humana to obtain a copy of records. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.
- Management of sites assigned and tracking of records received to a specified goal
- Document progress/calls made daily/complete daily productivity report
- Research site information/update information internally
- Collaboration...
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