Risk Adjustment Admin Professional

Risk Adjustment Administration Professional 1

Become a part of our caring community

The Risk Adjustment Administration Professional 1 responsible for uploading packets for CMS RADV (Risk Adjustment Data Validation) to CDAT (Central Data Abstraction Tool). Will also be responsible for any administrative review, claims review/investigation, working with different teams including the retrieval team. The Risk Adjustment Administration Professional 1 work assignments are often straightforward and of moderate complexity.

The Risk Adjustment Administration Professional 1 may conduct analysis of data uploaded to CMS, review of packets, and some claims review. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is driven by CMS deadline. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Use your skills to make an impact

Required Qualifications

• 2+ years of Microsoft Excel experience
• Software/applications navigation skills
• Cross validation of data sets experience
• Ability to verify member data matches prior to upload

Preferred Qualifications

• CAS claims experience reviewing and understanding
• Deadline driven prioritizing task to meet internal/external deadlines
• Task oriented completing assigned work and prioritizing assigned work
• Self motivated Takes initiative, works with minimal supervision
• Team player helping other team members after completing assigned work; asking for additional work when needed.

Core Responsibilities

• CMS RADV & CDAT: Uploading audit packets to the Central Data Abstraction Tool.
• Claims & Admin Review: Handling administrative claims review.
• Team Collaboration: Working closely with retrieval and other internal groups.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range $59,300 - $80,900 per year

Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our