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Humana Medical/Financial Risk Evaluation Professional 2- Remote, nationwide in Boston, Massachusetts


The Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk, and mitigates any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events. In this position, you will work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


Job Description

The hours are Mon-Fri providing coverage 6am-6pm EST with 8 hour flexible shifts to be determined.

Required Qualifications

  • Current Coding Certification with AAPC or AHIMA

  • Basic knowledge of CAS/MTV

  • Data analysis using Excel

  • Experience creating and presenting information to diverse audiences including senior leaders

  • Comfortable working in self-directed self-motivated environment

Work at Home/Remote Requirements

  • Must ensure designated work area is free from distractions during work hours and virtual meetings

  • Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

  • Background or knowledge of code edit processes - strongly preferred

  • Bachelor's degree or 5 years of Health Plan experience

  • Minimum 3 years experience with claims process **or correct coding

  • Demonstrated process development experience

  • Experience implementing claims payment edits or audits

  • Experience with relational databases (access or SQL) * optional

  • Adaptable to change

Scheduled Weekly Hours