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Entry Level Optum Health Coding Risk Adjustment Jobs in Tennessee

Humana, Inc.

Medical Coding Educator

Nashville, TN · On-site

$26.25 - $30/hr

Experience with healthcare risk adjustment, including HCC coding and CMS-HCC model version 28. * Experience speaking with leadership, webinars public speaking or presentation skills with healthcare ...

Altegra Health

Remote Certified Coders

Memphis, TN · Remote

$21.75 - $29.75/hr

... Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: Abstract pertinent information from patient medical records. Assign ...

Altegra Health

Remote Certified Coders

Memphis, TN · On-site +1

$21.75 - $29.75/hr

... Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities: • Abstract pertinent information from patient medical records. Assign appropriate ...

OneOncology

Manager, Coding

Nashville, TN · On-site

... risk adjustment coding and compliance * Evaluate and optimize end to tend practice clinical ... Minimum 3 years health care management/leadership experience required. * Minimum 3 years medical ...

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Entry Level Optum Health Coding Risk Adjustment information

What is an entry level Optum Health coding risk adjustment?

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 are the primary challenges faced by entry level Optum Health coding risk adjustment specialists, 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 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 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.

What are the most commonly searched types of Optum Health Coding Risk Adjustment jobs in Tennessee?

The most popular types of Optum Health Coding Risk Adjustment jobs in Tennessee are:

What are popular job titles related to Entry Level Optum Health Coding Risk Adjustment jobs in Tennessee?

For Entry Level Optum Health Coding Risk Adjustment jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Entry Level Optum Health Coding Risk Adjustment jobs in Tennessee look for?

The top searched job categories for Entry Level Optum Health Coding Risk Adjustment jobs in Tennessee are:

Entry Level Optum Health Coding Risk Adjustment jobs near you
Infographic showing various Entry Level Optum Health Coding Risk Adjustment job openings in Tennessee as of August 2026, with employment types broken down into 2% As Needed, 80% Full Time, 13% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

HCC Risk Adjustment Coder

Vertek Staffing

Franklin, TN • Remote

$18 - $24/hr

Contractor

Re-posted 27 days ago

Job description

HCC / Risk Adjustment Coder - Remote

Risk Adjustment / HCC Coding Experience Required

Required Education
  • High School Diploma required with submission
Required Certifications

Online certification verification required with submission.

Candidates must possess one of the following certifications:

  • Certified Professional Coder (CPC) - AAPC
  • Certified Risk Adjustment Coder (CRC) - AAPC
  • Certified Coding Specialist (CCS) - AHIMA
  • Registered Health Information Technician (RHIT) - AHIMA
  • Registered Health Information Administrator (RHIA) - AHIMA

CRC Certification is highly preferred.

Schedule
  • Monday - Friday
  • Occasional weekend coverage may be required based on client needs
Position Summary

The HCC / Risk Adjustment Coder is responsible for reviewing medical records and clinical documentation to accurately identify, validate, and code chronic and acute conditions impacting patient risk scores and reimbursement.

The coder will ensure accurate assignment of ICD-10-CM diagnosis codes in accordance with CMS Risk Adjustment guidelines, Official ICD-10-CM Coding Guidelines, and client-specific requirements. This role supports Risk Adjustment initiatives through retrospective chart reviews, prospective reviews, coding validation, provider education support, and quality assurance activities.

The HCC Coder will collaborate with providers, CDI professionals, quality teams, population health departments, and coding leadership to ensure complete and accurate capture of chronic conditions and disease burden.

Key Responsibilities
  • Review medical records to identify and code HCC-eligible diagnoses.
  • Assign ICD-10-CM diagnosis codes in accordance with CMS and Risk Adjustment guidelines.
  • Validate chronic conditions and ensure documentation supports code assignment.
  • Perform retrospective and prospective chart reviews.
  • Identify missed HCC opportunities and documentation gaps.
  • Assist with coding validation and quality assurance audits.
  • Support provider education initiatives regarding Risk Adjustment documentation requirements.
  • Maintain productivity and quality standards established by the client.
  • Participate in internal and external audit activities.
  • Stay current on CMS Risk Adjustment regulations, coding updates, and industry best practices.
  • Assist leadership with special projects and additional duties as assigned.
Required Experience
  • Risk Adjustment / HCC coding experience required
  • Strong understanding of ICD-10-CM coding guidelines
  • Experience reviewing outpatient and provider documentation
  • Knowledge of CMS-HCC Risk Adjustment methodologies
  • Experience validating chronic conditions and disease burden
  • Strong attention to detail and coding accuracy
Preferred Experience
  • CRC certification
  • Experience with Medicare Advantage populations
  • Experience with value-based care programs
  • Experience performing coding audits and quality reviews
  • Experience with Epic, Cerner, Athena, eClinicalWorks, NextGen, or other EMR systems
  • Experience educating providers on Risk Adjustment documentation
 
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About Vertek Solutions

Sourced by ZipRecruiter

Vertek Solutions is a boutique staffing firm that specializes in recruiting top level IT talent who can enhance our clients’ teams. Our team works every day to foster relationships with both our consultants and clients to understand their needs and ensure that we are providing a solution that is mutually beneficial.

Industry

Recruiting and staffing services

Company size

11 - 50 Employees

Headquarters location

Franklin, TN, US

Year founded

2006

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