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Entry Level Optum Health Coding Risk Adjustment Jobs

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

Who is Gather Health? We are a new and growing healthcare organization with a unique and innovative ... The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete ...

Boston Medical Center

Risk Adjustment Coder

$19.25 - $25.50/hr

Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include Certified Risk Adjustment ...

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

Who is Gather Health? We are a new and growing healthcare organization with a unique and innovative ... The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete ...

Medasource

Risk Adjustment Coder

Manhattan, NY · On-site

$20.75 - $27.50/hr

This role is responsible for reviewing and validating diagnosis coding, ensuring documentation accuracy, and supporting audit readiness initiatives related to CMS HCC risk adjustment programs.

CommonSpirit Health

Risk Adjustment Coder

Bakersfield, CA · Remote

$29.44 - $43.79/hr

... coding standards and healthcare regulations. Clear communication with providers and staff, along ... Work with network providers to improve clinical documentation to better support CMS Risk Adjustment ...

CommonSpirit Health

Risk Adjustment Coder

Bakersfield, CA · Remote

$29.44 - $43.79/hr

... coding standards and healthcare regulations. Clear communication with providers and staff, along ... Work with network providers to improve clinical documentation to better support CMS Risk Adjustment ...

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Entry Level Optum Health Coding Risk Adjustment information

What are the key skills and qualifications needed to thrive as an Entry Level Optum Health Coding Risk Adjustment specialist, and why are they important?

To thrive in an Entry Level Optum Health Coding Risk Adjustment role, you typically need a basic understanding of medical terminology, ICD-10 coding, and healthcare documentation, often supported by a Certified Professional Coder (CPC) or similar certification. Familiarity with coding software, electronic health record (EHR) systems, and risk adjustment methodologies is important for daily tasks. Attention to detail, analytical thinking, and effective communication are vital soft skills for ensuring coding accuracy and collaborating with healthcare providers. These skills and qualifications are essential to ensure precise risk adjustment coding, compliance with regulations, and the financial integrity of healthcare organizations.

What are the primary challenges faced by entry-level coders in Optum Health's risk adjustment team, and how can new hires successfully navigate them?

Entry-level coders in Optum Health's risk adjustment team often encounter challenges such as understanding complex medical terminology, accurately interpreting clinical documentation, and strictly adhering to coding guidelines. Additionally, adjusting to a fast-paced environment with productivity and quality targets can be demanding. New hires can succeed by participating in available training sessions, proactively seeking clarification from experienced team members, and regularly reviewing updated coding standards. Building strong communication with clinicians and fellow coders also helps ensure accuracy and efficiency in coding assignments.

What is an Entry Level Optum Health Coding Risk Adjustment position?

An Entry Level Optum Health Coding Risk Adjustment position is a role within Optum Health focused on reviewing medical records and accurately assigning diagnostic codes to ensure proper risk adjustment for healthcare plans. These professionals help ensure that health plans receive adequate funding based on the health status of their members, which is crucial for organizations participating in Medicare Advantage and other risk-adjusted programs. Entry-level employees in this field typically work under the supervision of more experienced coders, learning industry coding standards and guidelines such as ICD-10-CM. Strong attention to detail, understanding of medical terminology, and compliance with regulations are important aspects of this job.

What is the difference between Entry Level Optum Health Coding Risk Adjustment vs Entry Level Medical Coding Specialist?

AspectEntry Level Optum Health Coding Risk AdjustmentEntry Level Medical Coding Specialist
CertificationsCPR, CPC or equivalent preferredCPC or CCS certification often required
Work EnvironmentHealthcare insurance, payer organizations, risk adjustment teamsHospitals, clinics, outpatient facilities
Job FocusRisk adjustment coding for insurance reimbursement and risk managementClinical coding for medical procedures and diagnoses
Industry UsageHealth insurance, managed careHealthcare providers, hospitals

Entry Level Optum Health Coding Risk Adjustment roles focus on coding for insurance risk adjustment, requiring knowledge of payer guidelines. Entry Level Medical Coding Specialists primarily code clinical procedures and diagnoses for patient records. While both roles involve medical coding, the former emphasizes insurance and risk management, whereas the latter centers on clinical documentation. Understanding these differences helps job seekers target the right position based on their skills and career goals.

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Entry Level Optum Health Coding Risk Adjustment jobs near you
Infographic showing various Entry Level Optum Health Coding Risk Adjustment job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, 83% Full Time, and 16% Part Time. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution.
HEALTH CODER - HCC & RISK ADJUSTMENT

HEALTH CODER - HCC & RISK ADJUSTMENT

NORTH EAST MEDICAL SERVICES

Burlingame, CA • Remote

$42.79 - $48.75/hr

Other

Posted 18 days ago

Job description

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization’s quality outcomes and financial performance.

ESSENTIAL JOB FUNCTIONS:

  • HCC Coding and Risk Adjustment (RA) Program Support
    • Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
    • Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
    • Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
  • Provider Training and Clinical Documentation Improvement (CDI)
  • Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
  • Provide one-on-one and group training to providers and clinical staff to improve documentation quality and accuracy.
  • Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.
  • Data Analysis and Reporting
    • Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
    • Generate reports and dashboards to track coding performance and documentation accuracy.
    • Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.
  • Compliance and Continuous Improvement
    • Stay up to date with changes in coding, risk adjustment, and Medicare regulations.
    • Assist in the development and implementation of internal coding policies and procedures.
    • Participate in quality improvement initiatives related to coding and documentation.
    • Performs other job duties as required by manager/supervisor
  • Education & Certification:
    • BS/BA Degree in Health Science or General Education is required. 
    • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification is required.
    • Additional CDI or auditing certifications (CCDS, CDEO, CPMA) are preferred.
  • Experience:
    • Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
    • Experience in provider education, clinical documentation improvement (CDI), and chart audits.
    • Previous experience working in an IPA, managed care organization, or similar setting is strongly preferred.
  • Skills & Competencies:
    • Excellent communication, presentation, and interpersonal skills.
    • Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
    • Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
    • Proficiency in electronic health records (EHR) and coding software.
    • Strong analytical and problem-solving skills.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluency in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This a full-time position. 

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