From Home Optum Health Coding Risk Adjustment Jobs in Florida

Provider Performance & Coding Consultant

Transform healthcare. Empower providers. Improve lives.

Position Description

Are you passionate about improving healthcare delivery and helping providers succeed in a changing landscape? As a Provider Performance & Coding Consultant, you play a key role in guiding medical practices toward better performance, accurate coding, and optimized workflows. You will help providers transition from traditional fee-for-service models to value-based care, ensuring they deliver high-quality care while maintaining financial health.

This is a hands-on, client-facing role where you lead projects, educate providers, and support healthcare transformation. Youll work with a diverse team of professionals who are committed to making a difference in patient outcomes and provider success.

Job Functions and Duties

Client Engagement and Project Leadership

• Manage the full lifecycle of client projects, from kickoff to completion
• Develop customized work plans with clear goals, timelines, and deliverables
• Coordinate resources and activities across multiple practices
• Ensure projects meet quality standards and deadlines

Provider Education and Support

• Train providers and staff on documentation, coding, and billing best practices
• Prepare practices for audits and regulatory reviews
• Present performance insights and improvement strategies
• Serve as a trusted advisor on healthcare regulations and payer requirements

Workflow Optimization and Technology Integration

• Act as liaison between practices and electronic health record (EHR) vendors
• Support EHR adoption, configuration, and optimization
• Recommend workflow improvements to enhance efficiency and compliance
• Help practices align with MIPS, Promoting Interoperability, and other programs

Regulatory and Program Guidance

• Stay current with healthcare regulations, trends, and payer programs
• Educate clients on changes affecting coding, billing, and performance metrics
• Support practices in meeting public health agency requirements

Reporting and Communication

• Create and maintain weekly/monthly performance dashboards and reports
• Communicate project updates and recommendations clearly and professionally
• Collaborate with supervisors to review goals, progress, and challenges

Business Development and Revenue Support

• Assist with client acquisition and retention strategies
• Support Fee-for-Service consulting and other revenue-generating activities
• Promote services and solutions that enhance client performance

Knowledge, Skills, and Abilities

Required Knowledge and Experience

• Medical coding experience (certification from AAPC or AHIMA required)
• HEDIS knowledge and Medicare Advantage familiarity
• Experience with EHR systems and chart auditing
• Understanding of healthcare revenue cycles and quality improvement methods

Preferred Knowledge and Experience

• Certified Risk Adjustment Coder (HCC coding)
• Experience with practice transformation or process improvement
• Familiarity with Patient-Centered Medical Home models
• Knowledge of MIPS, Promoting Interoperability, and clinical operations
• Bachelors degree in Health Informatics, Health Services Administration, or related field

Skills and Abilities

• Strong project management and organizational skills
• Ability to work independently and manage multiple priorities
• Excellent written and verbal communication skills
• Comfortable with public speaking and client presentations
• Proficient in Microsoft Office (Outlook, Excel, PowerPoint, Word)
• Self-motivated, proactive, and adaptable in a fast-paced environment
• Knowledge of medical terminology and ability to apply it appropriately

Licenses, Certifications, and Legal Requirements

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS)
• Certified Risk Adjustment Coder (CRC) preferred
• Must meet all legal requirements for healthcare consulting roles

Work Schedule

• Monday to Friday, 8:00 AM 5:00 PM
• Occasional variations may include early mornings, evenings, or overnight travel based on client location/needs