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Full Time Optum Health Coding Risk Adjustment Jobs in Tennessee

Elevance Health

Coding Analyst Sr.

Nashville, TN

AAPC Certified Risk Adjustment Coder (CRC) is highly preferred. * Knowledge of medical terminology ... Who We Are Elevance Health is a health company dedicated to improving lives and communities - and ...

Elevance Health

Coding Analyst Sr.

Nashville, TN · On-site

AAPC Certified Risk Adjustment Coder (CRC) is highly preferred. * Knowledge of medical terminology ... Please be advised that Elevance Health only accepts resumes for compensation from agencies that ...

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Full Time Optum Health Coding Risk Adjustment information

What is a full time Optum Health coding risk adjustment?

A Full Time Optum Health Coding Risk Adjustment job involves reviewing medical records and coding data to ensure accurate risk adjustment for health plan members. Employees in this role typically analyze clinical documentation, assign diagnostic codes, and support compliance with regulatory requirements. Their work ensures that health plans receive appropriate reimbursement by capturing the complexity and severity of patient conditions. This role is essential to maintaining data integrity and supporting overall healthcare quality initiatives.

What are the key skills and qualifications needed to thrive as a full time Optum Health coding risk adjustment professional?

To excel in a Full Time Optum Health Coding Risk Adjustment role, you need a solid understanding of medical coding guidelines, risk adjustment models (such as HCC), and typically a certification like CPC or CRC. Proficiency with coding software, electronic health records (EHRs), and risk adjustment analytics platforms is crucial. Attention to detail, analytical thinking, and effective communication help ensure accuracy and collaboration in documentation and reporting. These skills are vital for optimizing compliant coding, improving patient outcomes, and supporting accurate reimbursement in value-based care environments.

What are some common challenges faced by full time Optum Health coding risk adjustment professionals, and how can they be addressed?

Professionals in Full Time Optum Health Coding Risk Adjustment roles often encounter challenges such as keeping up with frequent updates to coding guidelines, managing high volumes of complex patient data, and ensuring accuracy under tight deadlines. Staying current with ongoing training, leveraging available coding support resources, and collaborating closely with clinical teams can help address these challenges. Additionally, using advanced coding tools and regularly participating in team meetings can improve both accuracy and workflow efficiency.

What is the difference between Full Time Optum Health Coding Risk Adjustment vs Full Time Medical Coder?

AspectFull Time Optum Health Coding Risk AdjustmentFull Time Medical Coder
CertificationsCPR, CPC, or CCS often preferredCPR, CPC, or CCS typically required
Work EnvironmentHealthcare insurance, risk adjustment teamsHospitals, clinics, outpatient facilities
Industry UsageHealth insurance, risk managementHealthcare providers, hospitals
Job FocusRisk adjustment coding, data analysisMedical record coding, billing

Full Time Optum Health Coding Risk Adjustment roles focus on risk adjustment coding within health insurance companies, requiring knowledge of risk models and specific certifications. Full Time Medical Coders primarily work in healthcare facilities, concentrating on accurate medical record coding for billing. While both roles involve coding, their environments and focus areas differ significantly.

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Full Time Optum Health Coding Risk Adjustment jobs near you

RISK ADJUSTMENT CODING ASSOCIATE II

GALEN MEDICAL GROUP PC

Hixson, TN • On-site

Full-time

Life, Retirement

Posted 21 days ago

Job description

Risk Adjustment Coding Associate II
Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages.
Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. Galen is CHATTANOOGA'S Doctor!
Ideal candidate would have HCC/risk adjustment coding experience
Summary/Objective:
The EMR Coding Auditor II (ECA II) facilitates improvement in the overall quality, completeness, and accuracy of medical record documentation. The individual will perform medical record reviews based on CMS Quality Standards and validating active chronic problems for each patient and communicating with the physician to ensure Hierarchical Condition Coding is met, as well as accurate and up-to-date patient problem lists are documented in the EMR. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support resource utilization and patient outcomes.
The ECA II will be the designated trainer for new team members and provide training and support to others in the team as needed and under the direction of the Population Health Manager.
Essential Functions:
Coordinate Patient Services
  • Train new EMR Coding Auditors on processes and procedures of the role.
  • Provide support for the EMR Coding Auditor team.
  • Attend Payer based coding training available and share resources to the EMR Coding Auditor team.
  • Perform medical chart reviews to confirm adherence to AAPC clinical coding guidelines.
  • Complete audits daily to validate compliance with quality standards and HCC documentation.
  • Queries the provider to educate and improve individual patient documentation in the EMR.
  • Protects self and other team members by following all compliance, HIPAA and infection prevention guidelines and regulations.
  • Respects patients by recognizing their rights; maintaining confidentiality.
  • Assist patient's primary care provider with coordination of care/services to ensure the smooth transfer of member information across the continuum of care.
  • Maximize the use of resources to improve quality outcomes with reduction of unnecessary tests/procedures maintaining accurate and complete documentation in the medical record.
  • Proactively engage with patients, family and/or caregivers to educate and coordinate completion of necessary procedures or tests.

Establish and Maintain Quality Care Population Health Coordination
  • Independently monitors and reviews an assigned patient population.
  • May provide telephonic outreach to patients identified as high risk, with chronic condition(s) to assist with medical record requests, as needed.
  • Thorough understanding of ICD-10, CPT and complex co-morbidity coding.
  • Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the-art practices and participating in professional organizations regarding clinical quality measures and governmental regulations.

Other Duties/Responsibilities:
  • Promote the mission, vision, and values of Galen Medical Group.
  • Report to work on time and as scheduled.
  • Represent the organization in a positive & professional manner.
  • Must adhere to HIPAA guidelines at all times in order to maintain the highest level of patient confidentiality.
  • Comply with all organization policies and procedures.
  • Participate in performance improvement and continuous quality improvement activities.
  • Attend regular staff meetings and in-services as directed.
  • Consistently demonstrate the value of the team concept.
  • Other duties as assigned.

Knowledge/Skills/Abilities:
  • Excellent customer service skills.
  • Exceptional skills of independence, organization, verbal and written communication, problem-solving, professional interaction, and human relation skills, as well as analytical skills and problem-solving ability.
  • Must be PC literate with strong computer navigational skills, as well as extensive knowledge of Windows and Microsoft Office.
  • Knowledge of basic medical terminology.
  • Proficient with processes to build teams and participate in cross-functional teams.
  • Ability to work within specified timeframe requirements, including timeframes for goal achievement.

Qualifications:
Education:
  • Must be certified as procedural coder and maintain certification throughout employment.
  • Must have strong analytical, oral and written communication skills.
  • Associates Degree in related field preferred.

Experience:
  • Minimum of two years of healthcare experience required with one-year clinical experience preferred.
  • Minimum of two years of customer service experience required.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.
As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patients needs efficiently. Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.
Galen Medical Group is a member of the TN Drug-Free Workplace and it is a requirement that we conduct a pre-employment drug screen, as part of the hiring process.
Why should you apply?
  • 401(k) benefits.
  • Education reimbursement.
  • Holiday Pay.
  • Great earned time-off policy.
  • Company-paid Life Insurance & Long Term Disability.

Apply