Risk Adjustment Coder

Become a part of our caring community 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 ensures coding is accurate and properly supported by clinical documentation within the health record. Reviews medical records to report conditions that map to HCCs by reviewing medical record documentation and applying the appropriate ICD-10 diagnosis codes. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. Works on projects that may include making phone calls to providers. Works within broad guidelines with little oversight. Demonstrates a professional demeanor, strong work ethic, and is a reliable team player with a positive attitude. Utilizes effective written and verbal communication skills. Demonstrates Proficiency in using computers and relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools. Participates on special projects, in addition to daily responsibilities. Associates may be required to work mandatory overtime to meet business needs and ensure timely completion of operational tasks. Work hours: Training for the first 3 weeks will be Mon-Fri 8am- 4:30pm Eastern time in a virtual/remote classroom. After training, you will work a 40 hour shift Mon-Fri, within your own time zone. There will be occasional overtime to support business needs Use your skills to make an impact Required Qualifications At least one of the certifications from AAPC or AHIMA are required from the list below: CPC or CPC-A - Certified Professional Coder (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) Experience working in a goal-oriented environment that is production and quality driven. Must maintain annual continuing education requirements and remain in good standing with the coding credentialing body, AAPC or AHIMA. Must be able to attend a 3 week virtual classroom training, Monday-Friday 8am- 4:30pm Eastern time Must be able to work 40 hours a week, Monday – Friday, with the ability to work mandatory overtime as needed to support business needs. Must have a confidential work space in order to work effectively and independently without distractions. Proficient using relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools. Preferred Qualifications Proficient in the use of Microsoft Office systems Word and Excel Risk Adjustment Experience HCC Coding experience 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 The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $48,300 - $65,900 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. Application Deadline: 06-30-2026 About us About Humana: 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.