Risk Adjustment Representative 2

Humana

Quality assurance audits of medical records for Medicare and Medicaid programs. Conducting administrative tasks while ensuring compliance and accuracy in a remote environment.

Posted 4/29/2026full-timeRemote • Virginia, West Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $40,000 - $52,300 per yearWebsite

About the role

Key responsibilities & impact

Conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes
Performs varied activities and moderately complex administrative/operational/customer support assignments
Collect medical records to ensure accuracy of member information and obtain provider signatures
Upload verified documents to Cotiviti centralized repository
Follow state and federal regulations as well as internal policies and guidelines while retrieving medical records
Communicate with physician offices by phone and email to efficiently meet all deadlines
Maintain strict confidentiality and safeguard protected health information (PHI) in compliance with HIPAA guidelines
Independently manage workload within defined service level expectations

Requirements

What you’ll need

High School Diploma
Professional appearance and attitude
Must have reliable transportation
Demonstrated organizational skills
At least 3 years of technical experience
Proficiency in all Microsoft Office applications, including Word and Excel
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
Excellent communication skills, both verbal and written
Ability to travel locally 50% to 75% of the time.
Candidate to reside within Raleigh, Fayette, Greenbrier, Nicholas, Clay, Summers, Monroe, or Mercer counties in WV.
Ability to travel overnight occasionally

Benefits

Comp & perks

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
many other opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-9 codesICD-10 codesMicrosoft OfficeWordExcelmedical records auditingtechnical experiencedata accuracydocument verificationcomputers

Soft Skills

organizational skillscommunication skillsprofessional appearanceattitudeconfidentialitytime managementindependencecustomer supportattention to detailadaptability