Risk Adjustment Representative 3 - WAH Upstate NY or ME NH CT

Profile

Description

The Risk Adjustment Representative 3 works with regional provider offices to ensure timely submission of requested medical records 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.

Responsibilities

The Risk Adjustment Representative 3 is responsible for obtaining accurate healthcare information from providers to ensure appropriate clinical care for members and maintenance of accurate payment levels. This is to be completed all while following State and Federal regulations as well as internal policies and guidelines. The RAR3 will also perform job related administrative duties and special projects. Regularly exercises discretion and judgment in prioritizing requests, interpreting and adapting procedures processes and techniques. This position will work under limited guidance due to experience and depth of knowledge of administrative processes and organization knowledge.

Required Qualifications

At least 2 years of experience in a healthcare/managed care setting

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

Strong collaborative skills

Strong knowledge of Microsoft Office XP products (Word, Excel, Access)

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

Candidate must live in the Upstate NY region, or States of ME, CT or NH to be considered for this position

Preferred Qualifications

Bachelor's Degree

Knowledge and experience in health care environment/managed care

Additional Information

Scheduled Weekly Hours

40

Company info

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