From Home Optum Health Coding Risk Adjustment Jobs in Dallas, TX

Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services, certified in SOC2 compliance and specialize in revenue cycle optimization for hospitals, physician groups, and healthcare organizations across various specialties. We are proud to be recognized by Becker's Healthcare as one of the Top Revenue Cycle Management Companies to Know (2026), featured on the Inc. 5000 list of America's Fastest-Growing Private Companies, honored in the SMU Cox Dallas 100™ for multiple consecutive years, and recognized by Black Book Research as a leading healthcare RCM solutions provider.

Job Description:

We are seeking an experienced Client Success Manager- Medical Coding with expertise in medical coding, auditing, and compliance to oversee client relationships, coding operations, and revenue cycle optimization. This role requires a deep understanding of CPT, ICD-10, HCPCS, payer policies, and denial management, ensuring that clients receive best-in-class coding services and compliance support.

The ideal candidate will have a strong background in medical coding, compliance audits, RCM workflow optimization, and payer regulations, along with exceptional client relationship management skills.

Key Responsibilities:

Client Success & Relationship Management:

• Serve as the primary point of contact for clients, ensuring smooth communication and resolution of coding-related concerns.
• Develop and implement client engagement strategies to maximize satisfaction, retention, and revenue growth.
• Conduct Quarterly Business Reviews (QBRs) and compliance audits to drive process improvements.
• Identify upsell and cross-sell opportunities within client accounts to expand coding service offerings.

Medical Coding & Compliance Oversight:

• Ensure adherence to ICD-10, CPT, HCPCS, and payer-specific guidelines across multiple specialties.
• Conduct coding audits, documentation reviews, and risk assessments to improve coding accuracy and compliance.
• Monitor denial trends, coding discrepancies, and revenue leakage, implementing corrective actions as needed.
• Stay up to date with Medicare, Medicaid, and commercial payer regulations, ensuring regulatory compliance.
• Provide training and education to clients and internal teams on evolving coding guidelines and best practices.

Revenue Cycle & Denial Management:

• Optimize coding workflows, ensuring efficient charge capture and clean claim submission.
• Collaborate with billing, AR, and denial management teams to reduce denials, enhance revenue recovery, and improve coding accuracy.
• Track key performance indicators (KPIs) such as clean claim rates, denial rates, coding accuracy, and compliance scores.
• Drive coding automation initiatives to improve operational efficiency and minimize manual errors.

Cross-Functional Collaboration & Leadership:

• Work closely with operations, compliance, and technology teams to refine and enhance coding service offerings.
• Lead and mentor onshore and offshore coding teams, ensuring high performance and adherence to compliance standards.
• Partner with business development teams to support client onboarding, process improvement initiatives, and contract renewals.
• Act as an RCM Subject Matter Expert (SME) in internal strategy discussions and client engagements.

Required Qualifications:

• Bachelor’s degree in Healthcare Administration, Business, or a related field (Master’s preferred).
• 7+ years of experience in medical coding, auditing, and revenue cycle management in a leadership role.
• Certification required: CPC, CCS, or equivalent (AHIMA or AAPC certification preferred).
• Strong understanding of payer policies, claims processing, medical necessity guidelines, and risk adjustment methodologies.
• Experience in coding audits, denial resolution, and revenue integrity initiatives.
• Proficiency in RCM platforms, EHR/EMR systems (Epic, Meditech, Paragon, etc.).
• Experience managing onshore/offshore coding teams and handling multi-client engagements.
• Strong analytical, problem-solving, and negotiation skills with the ability to translate data into actionable insights.
• Willingness to travel as needed(35-50%).

Why Join Plutus Health Inc.?

• Work for a fast-growing, innovative company recognized for excellence in healthcare.
• Collaborate with a dynamic, supportive team that values professional development.
• Make a meaningful impact on patient care and operational success.