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From Home Optum Health Coding Risk Adjustment Jobs in Ohio

Premier Health

PHYSICIAN ADVISOR

Dayton, OH · On-site

... risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding ... Health's patient population. Key Responsibilities 1. Clinical Documentation Integrity (CDI ...

Premier Health

PHYSICIAN ADVISOR

Dayton, OH

... health system. This role focuses on optimizing case mix index (CMI ... risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding ...

Premier Health

PHYSICIAN ADVISOR

Dayton, OH · On-site

... risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding ... Health's patient population. Key Responsibilities 1. Clinical Documentation Integrity (CDI ...

Premier Health

PHYSICIAN ADVISOR

Dayton, OH

... health system. This role focuses on optimizing case mix index (CMI ... risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding ...

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All JobsOptum Health Coding Risk Adjustment JobsFrom Home Optum Health Coding Risk Adjustment JobsFrom Home Optum Health Coding Risk Adjustment Jobs in Ohio

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 the most commonly searched types of Optum Health Coding Risk Adjustment jobs in Ohio? The most popular types of Optum Health Coding Risk Adjustment jobs in Ohio are:
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From Home Optum Health Coding Risk Adjustment jobs near you
Infographic showing various From Home Optum Health Coding Risk Adjustment job openings in Ohio as of July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.
Risk Adjustment Coding Specialist

Risk Adjustment Coding Specialist

Trinity Health

Columbus, OH • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

Trinity Health rating

6.5

Company rating: 6.5 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

604th of 890 rated healthcare providers

Job description

Employment Type:
Full timeShift:
Description:
Position Purpose:
The Risk Adjustment Coder is responsible for reviewing and abstracting medical records to ensure accurate and complete diagnosis coding for risk adjustment purposes. This includes validating documentation using MEAT (Monitor, Evaluate, Assess, Treat) and TAMPER (Treatment, Assessment, Monitoring, Plan, Evaluation, Referral) principles to support Hierarchical Condition Category (HCC) coding. The coder also ensures accurate capture of Evaluation and Management (E&M) services and Current Procedural Terminology (CPT) codes to reflect the full scope of patient care and provider services. This role supports compliance, revenue integrity, and clinical documentation improvement through thorough review chart and collaboration with providers.
What You Will Do:
  • Reviews and evaluates patient medical records to determine the level of Evaluation and Management (E/M) service, identify office non-E/M procedures, and diagnoses. Accurately assigns and sequences CPT, modifiers, and ICD-10 codes. Abstracts and validates information.
  • Review patient medical records to identify and assign appropriate ICD-10-CM codes that map to HCCs.
  • Ensure documentation meets MEAT and/or TAMPER criteria to support the presence and management of chronic conditions.
  • Collaborate with providers to clarify documentation and educate on risk adjustment coding best practices.
  • Conduct retrospective and prospective coding reviews to identify missed or undocumented HCCs.
  • Maintain compliance with CMS, HHS, and payer-specific risk adjustment guidelines.
  • Participate in internal audits and quality assurance processes to ensure coding accuracy.
  • Provide feedback and training to clinical staff on documentation improvement opportunities.
  • Stay current with updates to coding guidelines, risk adjustment models (e.g., CMS-HCC, HHS-HCC), and regulatory changes.
  • Train and mentor peers and new coders on risk adjustment coding standards, MEAT/TAMPER documentation, and E&M/CPT capture.
  • Responsible for compliance with Organizational Integrity through raising questions and promptly reporting actual or potential wrongdoing.
  • All other duties as assigned.

Minimum Qualifications:
  • High School Diploma or Equivalent required
  • Licensure / Certification: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification required; Certified Risk Adjustment Coder (CRC) preferred.
  • Active and up to date CPC certification preferred
  • Completes and submits Medicare Patient Assessment Forms and maintains accurate database of submission and payment.
  • Minimum of two years of experience in medical coding and billing required.
  • Understanding of various medical claims formats.
  • Working knowledge in medical terminology, CPT and ICD-10 coding, and subsequent ICD versions.
  • Expanded knowledge of Risk Adjustment and HCC coding.
  • Knowledge of payer contracts and reimbursement.

Position Highlights and Benefits:
  • Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
  • Retirement savings account with employer match starting on day one.
  • Generous paid time off programs.
  • Employee recognition programs.
  • Tuition/professional development reimbursement starting on day one.
  • RN to BSN tuition 100% paid at Mount Carmel's College of Nursing.
  • Relocation assistance (geographic and position restrictions apply).
  • Employee Referral Rewards program.
  • Mount Carmel offers DailyPay - if you're hired as an eligible colleague, you'll be able to see how much you've made every day and transfer your money any time before payday. You deserve to get paid every day!
  • Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry/Facility Information:
Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you're seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

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About Trinity Health

Sourced by ZipRecruiter

Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Livonia, MI, US

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