Become a part of our caring community and help us put health first

The Risk Adjustment Representative 3 works with regional provider offices in Maryland and Delaware 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 in Maryland and Delaware works within defined parameters to identify work expectations and complete record retrieval in accordance with provided deadlines. The RAR3 is responsible for the following job duties and will also perform special projects when assigned:

• Directs communication with regional provider offices, facilities, and vendors to ensure commitment to submit requested medical records
• Completes remote medical record retrieval as assigned
• Performs assigned administrative duties
• Conducts site/claims research to ensure accurate information
• Maintains working knowledge of all retrieval and research related processes
• Provides operational support to Risk Adjustment Representative 2 associates
• Conducts new hire training
• Travels to provider offices in Maryland and Delaware for onsite record retrieval as necessary up to 75%

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

Use your skills to make an impact

Required Qualifications

• 2+ years of experience in a healthcare/managed care setting
• Strong knowledge of Microsoft Office products (Word, Excel)
• Strong written and verbal communication skills
• Strong analytical, organizational and time management skills
• Strong collaborative skills
• Must be available to travel up to 75% of the time
• Ability to travel overnight occasionally within the region (Northeast)
• This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
• Candidate must reside in MD or DE to be considered for this position

Preferred Qualifications

• Project management experience
• Knowledge of MS Teams

Additional Information

• Must be available to travel up to 75% of the time
• Candidate must reside in MD or DE to be considered for this position

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.

#LI-LM1

Scheduled Weekly Hours

40

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.