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Entry Level Optum Health Coding Risk Adjustment Jobs

Cano Health

Risk Adjustment Coder

Jupiter, FL · On-site

We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us. Job Summary The Risk Adjustment coder will identify, collect, assess ...

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82K - $108K/yr

Oscar is the first health insurance company built around a full stack technology platform and a ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

Oscar is the first health insurance company built around a full stack technology platform and a ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

Oscar is the first health insurance company built around a full stack technology platform and a ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

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All JobsEntry Level Optum Health Coding Risk Adjustment Jobs

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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What cities are hiring for Entry Level Optum Health Coding Risk Adjustment jobs? Cities with the most Entry Level Optum Health Coding Risk Adjustment job openings:
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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 June 2026, with employment types broken down into 1% As Needed, 26% Full Time, 31% Part Time, 1% Temporary, 40% Contract, and 1% Nights. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.
Risk Adjustment Coder

Risk Adjustment Coder

Cano Health

Jupiter, FL • On-site

Full-time

Posted 28 days ago

Cano Health rating

7.6

Company rating: 7.6 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

It's rewarding to be on a team of people that truly believe in making an impact!
We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.
Job Summary
The Risk Adjustment coder will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. The Risk Adjustment Coder is required to follow procedures and documentation policies regarding claim/encounter information and provide appropriate support to justify their recommendations.
Duties & Responsibilities
Essential Duties & Responsibilities
  • Review medical record information to identify all appropriate coding based on CMS HCC categories
  • Prepare the medical charts and track patient information via Excel spreadsheets.
  • Complete appropriate paperwork/documentation/system entry regarding claim/encounter information
  • Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards
  • Provide real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS and STARS
  • Monitor coding changes to ensure that most current information is available
  • Work HCC suspect reports
  • Accurately code and submit encounters on a timely basis
  • Researching and addressing code questions for multiple provider offices as directed
  • Update the Director on the status on a weekly basis
  • Notifies Patient Experience Manager if annual wellness visits for patients have not been scheduled.
  • Travel to offices as necessary to complete on-site chart reviews
  • Performs post-audits on assigned offices and notifies office contact when codes are not addressed for provider review.
  • Support and participate in process and quality improvement initiatives.
  • Assists with billing claims as assigned.

Additional Duties & Responsibilities
  • Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Due to the nature of this position, it is understood that coding requirements are expected to change; therefore, participation in affiliated classes and individual efforts to maintain current knowledge of these changes is required.

Education & Experience
  • Two (2) years prior medical coding experience
  • Proficient in Microsoft Word and Excel
  • Strong organization and process management skills
  • Strong collaboration and relationship building skills
  • High attention to detail
  • Excellent written and verbal communication skills
  • Ability to learn new tasks and concepts
  • CPC, CPC-A or CCS-P, CRC Coding Certification

Knowledge, Skills & Proficiencies
  • Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments and takes responsibility for the impact of one's actions.
  • Pursues Excellence: Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to the managed care plan.
  • Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces changes and constructively resolves barriers and constraints.
  • Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that places emphasis on the success of the medical centers and insurance companies.

Job Requirements
Physical Requirements
This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Tools & Equipment Used
Computer and peripherals, standard and customized software applications and tools, and usual office equipment.
Disclaimer
The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
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