Risk Adjustment Coder

Employment Type: Full time

Position Overview

Become a part of our caring community and help us put health first. The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Risk Adjustment Coder will support our Corporate Coding Operations within the Healthcare Quality Reporting & Improvement (HQRI) department of Humana.

The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. They follow state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.

Responsibilities

• Conduct quality assurance coding of medical records and ICD-10 diagnosis codes.
• Submit coding information to CMS and other government agencies.
• Perform advanced and highly specialized administrative/operational/customer support duties.
• Analyze coding information and medical records, ensuring accuracy and proper support from clinical documentation.
• Adhere to state and federal regulations, internal policies, and guidelines.
• Work on projects that may include making phone calls to providers.
• Work within broad guidelines with little oversight.
• Participate in special projects, in addition to daily responsibilities, which may involve overtime.

Requirements

• Certifications: At least ONE of the following certifications from AAPC or AHIMA is required:
  • CPC - Certified Professional Coder (AAPC)
  • CPC-A Certified Professional Coder Apprenticeship (AAPC)
  • COC - Certified Outpatient Coder (AAPC)
  • CIC - Certified Inpatient Coder (AAPC)
  • CRC - Certified Risk Coder (AAPC)
  • CCA - Certified Coding Associate (AHIMA)
  • CCS - Certified Coding Specialist (AHIMA)
  • CCS-P - Certified Coding Specialist-Physician Based (AHIMA)
• Must maintain annual continuing education requirements and remain in good standing with the certification governing body.
• Must be able to work in a goal-oriented environment that is production and quality driven.
• Must be able to work 40 hours a week, 8-hour shifts, Monday – Friday, with the ability to work overtime as needed to support the business.
• Must be able to work within the hours of 8 a.m. - 4:30 p.m. EST for the first 3 weeks of virtual classroom training.
• Must be able to work effectively and independently without distractions.
• Must have good working knowledge of computers, and a demonstrated technical aptitude and an ability to quickly learn new systems.
• Must implement a professional demeanor, strong work ethic, be reliable, resourceful, an enthusiastic team player, and maintain a positive attitude.
• Must utilize effective written and verbal communication skills.

Preferred Qualifications

• Risk Adjustment Experience.
• Coding Experience.
• Proficient in the use of Microsoft Office systems (Word and Excel).

Additional Information

• Training: 3 weeks of Virtual Classroom training between the hours of 8:00 A.M. – 4:30 P.M. Eastern Standard Time (EST) with no time off during these first 3 weeks. This will be followed by an additional 8-12 weeks of mentoring/ongoing training. The training is scheduled for September 8th, 2025.
• Work Days/Hours: After Training, the expectation is to work Monday – Friday and you must be able to work an 8-hour shift for 40 hours a week.
• Work Style: Remote
• Work at Home/Remote Requirements:
  • Internet Service: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular, and microwave connections can be used only if approved by leadership.
  • For associates who live and work from home in California, Illinois, Montana, or South Dakota, a bi-weekly payment for internet expenses will be provided.
  • Humana will provide home or hybrid home/office associates with telephone and computer equipment appropriate to meet business requirements.