Risk Adjustment Representative

Description

The Risk Adjustment Representative 3 position is a scheduling role for medical record retrieval that will specialize in working with the third-party medical record vendors in the Gulf South retrieval area. The candidate will work from home Monday - Friday, 8am to 5pm calling provider offices, hospitals, specialty clinics and third-party vendors to obtain medical records. They may also assist with scheduling the retrieval team members for site appointments.

Responsibilities

The Risk Adjustment Representative 3 role is to primarily coordinate the record retrieval for the third-party vendors to obtain medical records within the Gulf South retrieval area. This role involves handling multiple projects at the same time with different overall goals and deadlines that are determined by both the risk adjustment corporate leadership and the Gulf South Leadership.

• Obtains medical records through multiple entities and ensuring the accuracy of the scheduling database
• Makes multiple daily phone calls to provider offices, hospitals, third party vendors and specialty clinics to obtain medical records to meet seasonal/yearly production goals
• Production driven, high paced and requires remarkable communication skills
• Handles multiple tasks throughout the day, prioritize while staying very organized and maintain professional composure at all times
• Works in the scheduling system (Cotiviti), monitoring and maintaining hundreds of provider locations, working with copy services, retrieving business associate agreements for all third-party vendors, sending faxes, fielding incoming calls, scheduling retrieval staff, researching providers, maintaining proper invoicing procedures as well as constant follow up with all assigned projects
• Interacts with provider staff, consisting of front desk associates, office managers, nurses, medical record associates and individual doctors. Phone calls are not always pleasant, so a professional demeanor is key and required for the role
• Represents Humana, in a professional manner at all times
• Other tasks include but are not limited to; research projects, trouble shooting for retrieval staff, effectively managing email and phone calls, working within instant messaging (Teams), working with excel spreadsheets for multiple assigned projects and other administrative tasks as assigned by leadership.

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 8 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

               

Required Qualifications                                                                                            

• 2 years of administrative, medical administration or provider office experience
• Proficient in the use of technology; demonstrated technical aptitude
• Proficiency in all Microsoft Office applications, Excel and Word
• Strong written and verbal communication skills, organizational and time management skills
• Proficient in calendar management
• Ability to thrive in a very challenging and multitasking environment
• This role is part of Humana’s Driver safety program and requires candidates to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
• Ability to lift 50lbs
• Must have reliable transportation/ valid driver's license

​Preferred Qualifications

• Experience in a health care environment with medical records
• Previous experience with phone calls and managing appointment schedules
• Experience with entering data live within databases

Additional Information 

This candidate can live in the following states: TN, AL, MS, and LA.

Work at Home/Remote Requirements

Work-At-Home Requirements

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota.  Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire.  Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. 

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview.  Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

Humana is more than an equal opportunity employer, Humana’s dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles.  Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful.

This is a remote position.

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Scheduled Weekly Hours

40