Risk Adjustment Compliance Professional 2

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

The Risk Adjustment Compliance Professional 2 supports the organization’s adherence to governmental and contractual requirements, with a focus on risk adjustment operations. The role involves varied work assignments that require analysis, interpretation or regulatory guidance, and sound judgement in determining appropriate actions within established framework.

The Risk Adjustment Compliance Professional 2 contributes to the execution of the organization’s risk adjustment compliance program by supporting and the development and implementation of policies, conducting issue research, and assisting in monitoring activities.  This role collaborates with cross-functional teams to ensure operational processes align with CMS regulations and contractual obligations.

Key responsibilities include:

• Assisting in the development, implementation, and maintaining of compliance policies and procedures related to risk adjustments activities, including coding accuracy, encounter data submission, and chart review practices.
• Conducting research on compliance issues and providing recommendations to ensure adherence to CMS guidelines and contractual requirements.
• Supporting ongoing monitoring and auditing activities to identify potential compliance risks and ensure timely remediation.
• Coordinating logistics for regulatory site visits and assisting in tracking and follow-up of corrective action plans.
• Building working relationships with internal stakeholders and supporting external audit preparation efforts.
• Demonstrating an understanding of departmental and organizational goals and how risk adjustment compliance supports boarder business priorities.

Making decisions with established policies and procedures and seeking guidance in complex or ambiguous situations.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree
• Less than 5 years of technical experience
• Advance skills in Excel
• Ability to manage multiple or competing priorities and meet deadlines
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Strong attention to detail
• Experience running queries and ad hoc reports in Access and/or SQL

Preferred Qualifications

• Compliance regulations experience
• Analytical experience
• Graduate degree

Additional 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.

 

$65,000 - $88,600 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 07-31-2025

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.

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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.