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Full Time Optum Health Coding Risk Adjustment Jobs in Tennessee

OneOncology

Manager, Coding

Nashville, TN · On-site

... risk adjustment coding and compliance * Evaluate and optimize end to tend practice clinical ... Minimum 3 years health care management/leadership experience required. * Minimum 3 years medical ...

Wellpath

Actuary Senior Director

Franklin, TN

Overview The Actuary Senior Director provides strategic leadership across healthcare actuarial functions, including medical and pharmacy claims analysis, reserving, risk adjustment, and enterprise ...

Covenant Health

SUPV HEALTH INFO MGMT

Knoxville, TN · On-site

Health Information Management Supervisor Full Time, 80 Hours Per Pay Period, Day Shift Covenant ... Monitors to ensure transcription, coding, release of information, and HIM clerical activities are ...

Covenant Health

SUPV HEALTH INFO MGMT

Knoxville, TN · On-site

Health Information Management Supervisor Full Time, 80 Hours Per Pay Period, Day Shift Covenant ... Monitors to ensure transcription, coding, release of information, and HIM clerical activities are ...

Covenant Health

SUPV HEALTH INFO MGMT

Knoxville, TN · On-site

Overview Health Information Management Supervisor Full Time, 80 Hours Per Pay Period, Day Shift ... Monitors to ensure transcription, coding, release of information, and HIM clerical activities are ...

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All JobsOptum Health Coding Risk Adjustment JobsFull Time Optum Health Coding Risk Adjustment JobsFull Time Optum Health Coding Risk Adjustment Jobs in Tennessee

Full Time Optum Health Coding Risk Adjustment information

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 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 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.

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 are the most commonly searched types of Optum Health Coding Risk Adjustment jobs in Tennessee? The most popular types of Optum Health Coding Risk Adjustment jobs in Tennessee are:
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Full Time Optum Health Coding Risk Adjustment jobs near you

Coding Auditor - University Health Network

University Physicians Association, Inc.

Knoxville, TN • On-site

$23.50 - $26.75/hr

Full-time

Re-posted 5 days ago

Job description

Job Type
Full-time
Description
University Health Network is seeking a Full-Time Coding Auditor. This role requires normal business hours Monday-Friday and is a remote position with occasional on-site meetings. Candidate must be able to maintain HIPAA privacy requirements when working from home. Candidate must be located in the Knoxville, TN region.
UHN Auditor provides superior customer experience by educating internally and externally of errors and opportunities for improvement discovered during routine auditing. This individual will work closely with management to implement benchmarks, establish acceptable thresholds, and effective quality assurance programs. The UHN Auditor performs duties in a professional manner while exercising good judgment and ethical standards, interacts effectively and builds respectful working relationships across the organization, and demonstrates integrity by adhering to high standards of personal and professional conduct. This individual must be reliable and maintain a high level of confidentiality within all aspects of job performance.
Essential Duties and Responsibilities
  • Assists Coding Manager in developing and maintaining a quality assurance program
  • Performs audits and medical chart reviews contributing to the continual improvement of coding and documentation compliance performance.
  • Performs routine internal audits for the UHN Coding team utilizing the UHN Audit tool to assign accuracy rates.
  • Provides feedback and education to Coding Staff on accuracy scores and areas of improvement while maintaining confidentiality of individual performance.
  • Works with Coding Manager on improvement plan if team member's accuracy rate falls below industry standard and monitors if improvement plan is achieving desired outcome.
  • Assists in the development of an effective training program regarding correct coding techniques.
  • Performs external coding audits for providers and creates audit summary reports with education topics.
  • Delivers Audit results and educational opportunities to providers
  • Assists in development of educational materials regarding compliant coding practices
  • Acts as a Subject Matter Expert in coding and documentation compliance
  • Conducts special studies/projects as requested to identify opportunities for operational improvements
  • Assists in the maintenance and creation of departmental policies and procedures to ensure compliance with established State and Federal regulations.
  • Monitor database entries to ensure data is complete, accurate, and thorough
  • Remains current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance, and CMS Risk Adjustment guidance.
  • Performs ambulatory and inpatient coding assignments as needed to meet department deadlines.

Maintains HIPPA Guidelines for privacy
  • Respects the privacy of all patients 100% of the time
  • Obtains consent to release protected health information
  • Understands and abides by the HIPAA policy set forth by UHN
  • Reports all HIPAA issues to the Office Supervisor

Remains current on coding rules and guidelines
  • Remains up to date with official AMA ICD-10 coding guidelines and regulations, Medicare, other MA and commercial plans, and internal guidelines
  • Remains up to date with CMS and HHS HCC risk adjustment models
  • Ensures coding staff is current on coding rules and guidelines
  • Meets CEU requirements and remains in good standing with AAPC/AHIMA certifications

Requirements
  • 3+ years of ICD-10, CPT, and HCPCS coding experience required.
  • Experience and knowledge of Risk Adjustment Coding.
  • Current certifications required: CPC (RHIT also accepted) and CPMA.
  • Certified Risk Adjustment Coder (CRC) required within 6 months of hire.
  • Thorough understanding of healthcare compliance with experience in auditing E/M services and providing professional constructive feedback regarding billing and documentation practices.
  • Thorough understanding of Medicare/Medicaid billing regulations and documentation guidelines.
  • Strong knowledge of chart auditing/abstracting process.
  • Effective communication, relationship-building and interpersonal skills.
  • Exceptional attention to detail and proficiency in Microsoft Word and Excel.
  • Strong organizational and time management skills.
  • Ability to work independently and meet quality of work and workload expectations.
  • Strong analytical and problem-solving skills.

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