Job Overview
Location
Work at Home - West Virginia
Job Type
Full-time
Category
Other
Date Posted
April 28, 2026
Full Job Description
đź“‹ Description
- • The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies, ensuring accuracy and compliance in healthcare data reporting.
- • Day-to-day responsibilities include traveling up to 50-75% of the time to retrieve medical records from physician offices, using a laptop and portable scanner to collect and upload documents, scheduling appointments to meet deadlines, and maintaining strict confidentiality of protected health information in compliance with HIPAA.
- • The role operates within Humana’s CenterWell healthcare services, supporting accurate risk adjustment processes that directly impact reimbursement and care quality for Medicare and Medicaid members.
- • This position offers the opportunity to develop expertise in healthcare compliance, medical documentation, and data integrity while working independently within defined service levels and contributing to improved patient outcomes through precise data handling.
🎯 Requirements
- • High School Diploma or equivalent
- • At least 3 years of technical experience
- • Proficiency in Microsoft Office applications, including Word and Excel
- • Valid state driver’s license and proof of personal vehicle liability insurance with minimum 100/300/100 limits
- • Ability to travel locally 50% to 75% of the time and reside within specified West Virginia counties (Raleigh, Fayette, Greenbrier, Nicholas, Clay, Summers, Monroe, or Mercer)
🏖️ Benefits
- • Medical, dental, and vision insurance coverage
- • 401(k) retirement savings plan with company match
- • Paid time off including holidays, volunteer time, and parental/caregiver leave
- • Short-term and long-term disability, life insurance, and other wellness benefits
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
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