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Full Time Optum Health Coding Risk Adjustment Jobs in Tennessee

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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.

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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For Full Time Optum Health Coding Risk Adjustment jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Full Time Optum Health Coding Risk Adjustment jobs in Tennessee look for?

The top searched job categories for Full Time Optum Health Coding Risk Adjustment jobs in Tennessee are:

What cities in Tennessee are hiring for Full Time Optum Health Coding Risk Adjustment jobs?

Cities in Tennessee with the most Full Time Optum Health Coding Risk Adjustment job openings:

Full Time Optum Health Coding Risk Adjustment jobs near you

Risk Adjustment Expert - AI Trainer

Mercor

Nashville, TN • Remote

$110/hr

Full-time

Posted 8 days ago

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Risk-adjustment / HCC coding leader
Type: Contract
Compensation: $110/hour
Location: Remote

Role Responsibilities

  • Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA risk adjustment programs.
  • Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy and regulatory compliance.
  • Review medical records to ensure complete and accurate capture of HCC-eligible conditions supported by clinical documentation.
  • Conduct and oversee retrospective and prospective chart reviews for risk score optimization.
  • Manage RADV audit preparation and response processes.
  • Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes.

Qualifications

Must-Have

  • 5+ years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations, with at least 2 years in a leadership role.
  • Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologies.
  • Strong knowledge of ICD-10-CM coding guidelines as applied to HCC risk adjustment.
  • Experience with RADV audit preparation and CMS compliance requirements.
  • Familiarity with RAPS and EDGE submission processes.
  • Exceptional written and verbal English communication skills.
  • High attention to detail with the ability to identify coding inaccuracies and documentation gaps in AI-generated outputs.

Preferred

  • CRC (Certified Risk Coder), CCS, CPC, or RHIA credential.
  • Experience with risk adjustment analytics platforms and chart retrieval systems.
  • Background in health plan, Medicare Advantage organization, or value-based care setting.
  • Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content.
  • Experience presenting risk adjustment performance to actuarial or executive teams.

Application Process (Takes 20–30 mins to complete)

  • Upload resume
  • AI interview based on your resume
  • Submit form

Resources & Support

  • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
  • For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.


#hiringmercor