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From Home Optum Health Coding Risk Adjustment Jobs in Chicago, IL

Strive Health

Nurse Practitioner

Merrillville, IN · On-site

Hybrid-Remote Flexibility -Work from home while fulfilling in-person needs at the office, clinic ... Accurately documents and captures diagnoses to support risk adjustment (HCC coding), identify and ...

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From Home Optum Health Coding Risk Adjustment information

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How much do from home optum health coding risk adjustment jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for from home optum health coding risk adjustment in Chicago, IL is $22.15, according to ZipRecruiter salary data. Most workers in this role earn between $18.56 and $23.51 per hour, depending on experience, location, and employer.

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.
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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 Chicago, IL as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $46,072 per year, or $22.1 per hour.

Senior Manager, Corporate Compliance - Risk Adjustment

CVS Health

Northbrook, IL

$75K - $165K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 11 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,326 frontline employees who took The Breakroom Quiz

88th of 110 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.

The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.

Key Responsibilities

  • Lead the Medicare Advantage Risk Adjustment compliance program.

  • Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.

  • Assess operational processes for compliance risks related to risk adjustment activities.

  • Develop and implement corrective action plans for identified compliance issues.

  • Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.


Required Qualifications

  • Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance

  • Minimum 5 years in a leadership role

  • One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)

  • Willingness to travel up to 10% (including by plane)


Preferred Qualifications

  • Health Information Management (RHIA/RHIT)

  • Nursing - Strong understanding of clinical documentation and medical record review

  • Certified Risk Adjustment Coder (CRC) with compliance experience

  • Provider coding audit/compliance leadership experience

  • Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits


Education

Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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