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From Home Optum Health Coding Risk Adjustment Jobs in Florida

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 ... While your daily work will be completed from your home office, occasional travel may be required ...

Centrum Health

Risk Adjustment Analyst

Doral, FL

SCOPE OF ROLE The Risk Adjustment and Analytics Team is working to push boundaries to redefine Risk ... Using SQL code, mine data on medical spend, clinical data and population health data and derive ...

Cano Health

Risk Adjustment Coder

Jupiter, FL

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 ...

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 ...

Centrum Health

Risk Adjustment Analyst

Doral, FL · On-site

The Risk Adjustment Analyst will be the lead in the design, implementation, and maintenance of all ... Using SQL code, mine data on medical spend, clinical data and population health data and derive ...

Msmc

Certified Risk Adjustment Coder

Hialeah, FL · On-site

$20.50 - $27.75/hr

... top healthcare workers from across the country. We offer the latest in advanced medicine ... Demonstrates knowledge of coding and documentation standards as well as CMS risk adjustment ...

Lee Health

HCC Coding Educator

Fort Myers, FL · On-site +1

$27.57 - $35.84/hr

Associate's degree in health information management, nursing, healthcare administration or related field required. Experience: Minimum of 3 years' experience in HCC coding and risk adjustment.

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From Home Optum Health Coding Risk Adjustment information

What is the difference between From Home Optum Health Coding Risk Adjustment vs From Home Optum Health Medical Coding?

AspectFrom Home Optum Health Coding Risk AdjustmentFrom Home Optum Health Medical Coding
CertificationsCCS, CPC, or RHIT/RHIACCS, CPC, or RHIT/RHIA
Work EnvironmentRemote, home-basedRemote, home-based
Industry UsageHealth insurance, risk adjustment programsHealthcare providers, hospital coding
Job FocusRisk adjustment coding for insurance accuracyClinical coding for medical records

While both roles involve medical coding from home, From Home Optum Health Coding Risk Adjustment focuses on coding for insurance risk adjustment programs, requiring specific risk adjustment knowledge. In contrast, From Home Optum Health Medical Coding emphasizes clinical coding for medical records, often in hospital or provider settings. Both roles require similar certifications and offer remote work, but their primary focus and industry applications differ.

Does Optum allow remote work?

Optum Health Coding Risk Adjustment roles typically offer remote work options, allowing employees to perform their duties from home. These positions often require familiarity with coding software and adherence to healthcare privacy standards, with flexible schedules in many cases.

What is an Optum HCC coder job description?

An Optum HCC coder is responsible for reviewing and abstracting medical records to assign Hierarchical Condition Category (HCC) codes that reflect patient health status for risk adjustment. They ensure accurate coding in compliance with CMS guidelines, often using coding software and requiring knowledge of medical terminology and coding standards. The role typically involves remote work, attention to detail, and may require certification such as CPC or CCS.

How much can you make working from home as a medical coder?

Medical coders working from home, including those in risk adjustment roles like Optum Health Coding, typically earn between $40,000 and $70,000 annually, depending on experience, certifications, and workload. Advanced skills and certifications such as CPC or CCS can lead to higher pay, and remote positions often offer flexible schedules and the use of coding software tools.

Will a medical coder be replaced by AI?

Medical coders, including those specializing in risk adjustment for health plans, perform complex tasks that require understanding medical records and applying coding guidelines. While AI tools can assist with coding accuracy and efficiency, they are unlikely to fully replace human coders due to the need for clinical judgment and nuanced decision-making. Coders with skills in coding systems like ICD-10 and familiarity with electronic health records remain essential in the industry.
What are popular job titles related to From Home Optum Health Coding Risk Adjustment jobs in Florida? For From Home Optum Health Coding Risk Adjustment jobs in Florida, the most frequently searched job titles are:
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From Home Optum Health Coding Risk Adjustment jobs near you
Auditor, Risk Adjustment

Auditor, Risk Adjustment

Oscar Health

Miami, FL • Remote

$82K - $108K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

237th of 277 rated insurance

Job description

Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Associate, Risk Adjustment Auditor conducts internal and external quality audits. Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

You will report into the Manager, Risk Adjustment.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
  • Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
  • Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
  • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
  • Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
  • Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
  • Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
  • Manage the implementation process improvements that will maximize risk adjustment factor increases.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Bachelor's degree in a relevant field of study or commensurate work experience.
  • Certified professional coder (CPC)
  • 3+ year(s) retrospective risk adjustment coding experience.
  • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Bonus points:

  • Certified Risk Adjustment Coder (CRC) or similar certification
  • Experience coding in a variety of different Electronic Medical Record (EMR) systems.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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