From Home Optum Health Coding Risk Adjustment Jobs

We are seeking a detail-oriented Risk Adjustment Coding Auditor to support the accuracy, integrity, and compliance of clinical coding data across risk adjustment programs. In this role, you will conduct audits, review medical record documentation, identify coding opportunities, and provide guidance on coding accuracy to help support compliant reporting and appropriate reimbursement.

The ideal candidate will bring extensive HCC coding and risk adjustment auditing experience, strong analytical skills, and a thorough understanding of Medicare, Medicaid, and ACA risk adjustment models.

• Perform retrospective and prospective chart reviews to evaluate risk adjustment diagnosis coding accuracy.
• Audit medical records to verify the completeness, specificity, and appropriateness of reported diagnoses.
• Review clinical documentation to ensure accurate HCC capture and risk adjustment reporting.
• Evaluate coding practices for compliance with CMS guidelines, industry standards, and organizational policies.
• Identify coding discrepancies, documentation gaps, and opportunities for improvement.
• Provide written and verbal feedback regarding coding errors, trends, and audit findings.
• Serve as a subject matter resource for risk adjustment coding and audit processes.
• Support audit production goals and meet established turnaround times and deadlines.
• Participate in risk mitigation reviews and special projects as assigned.
• Maintain compliance with HIPAA, privacy, security, and regulatory requirements.
• Stay current on coding regulations, risk adjustment methodologies, and industry updates.

• 7+ years of related professional experience.
• 5+ years of HCC coding experience utilizing inpatient and outpatient coding guidelines.
• 5+ years of experience auditing risk adjustment records.
• 1+ year of experience working in a production-based environment.
• CRC (Certified Risk Coder) certification in good standing.
• Knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models.
• Ability to interpret and apply coding policies, regulations, and guidelines.
• Experience providing coding education, audit feedback, and trend analysis.
• Intermediate proficiency with Microsoft Office Suite (Excel, Word, PowerPoint, and Outlook).
• Strong organizational, analytical, and time management skills.
• Ability to manage multiple priorities in a deadline-driven environment.
• High school diploma or equivalent.

• Bachelor's degree.
• HEDIS and/or STARS experience.
• Provider education experience.
• Risk Adjustment Data Validation (RADV) experience.
• CPMA or additional coding credentials.
• Experience with NLP (Natural Language Processing) software.
• RHIT or RHIA certification combined with strong risk adjustment coding experience.

• Risk Adjustment Auditing
• HCC Coding
• ICD-10-CM Coding
• Risk Adjustment Programs
• Medicare Advantage
• Medicaid
• ACA Commercial Plans
• Clinical Documentation Review
• Healthcare Compliance
• Medical Record Auditing
• Coding Education & Feedback
• Quality Assurance
• HIPAA Compliance
• Data Integrity
• Microsoft Office Suite

• Strong attention to detail and commitment to coding accuracy.
• Excellent critical thinking and problem-solving abilities.
• Effective written and verbal communication skills.
• Ability to work independently while collaborating with cross-functional teams.
• Commitment to maintaining compliance and high-quality audit standards.

Job Type & Location

This is a Contract position based out of Phoenix, AZ.

The pay range for this position is $32.00 - $37.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Aug 4, 2026.

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.