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Full Time Optum Health Coding Risk Adjustment Jobs in Chicago, IL

Bcbsa

Head of Medicare Performance Hub

Chicago, IL · On-site

... Health Risk Assessment (HRA) program performance Partner with Plans and the analytics vendor to surface Risk Adjustment coding opportunities at the member level, including prospective and ...

Endeavor Health

Senior Coding Educator

Skokie, IL

$32.60 - $48.90/hr

Location: Skokie, IL * Full Time * Hours: Monday-Friday, 8:00am-4:30pm A Brief Overview: The ... Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related ...

Endeavor Health

Senior Coding Educator

Skokie, IL

$32.60 - $48.90/hr

Location: Skokie, IL * Full Time * Hours: Monday-Friday, 8:00am-4:30pm A Brief Overview: The ... Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related ...

Bcbsa

Medicare Plan Management Principal

Chicago, IL · Hybrid

... healthcare program expertise, stakeholder influence, and the ability to translate complex program requirements - spanning Star Ratings, Risk Adjustment, and Medical Cost Management - into clear ...

NorthShore

Senior Coding Educator

Skokie, IL · On-site

$32.60 - $48.90/hr

Location: Skokie, IL * Full Time * Hours: Monday-Friday, 8:00am-4:30pm A Brief Overview: The ... Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related ...

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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 Chicago, IL

Full Time Optum Health Coding Risk Adjustment information

See Chicago, IL salary details

$15

$27

$39

How much do full time optum health coding risk adjustment jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for full time optum health coding risk adjustment in Chicago, IL is $27.15, according to ZipRecruiter salary data. Most workers in this role earn between $22.31 and $30.48 per hour, depending on experience, location, and employer.

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 Chicago, IL?

The most popular types of Optum Health Coding Risk Adjustment jobs in Chicago, IL are:

What are popular job titles related to Full Time Optum Health Coding Risk Adjustment jobs in Chicago, IL?

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

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

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

Full Time Optum Health Coding Risk Adjustment jobs near you

Senior Manager, Corporate Compliance - Risk Adjustment

CVS Health

Northbrook, IL

$75K - $165K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 5 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,351 frontline employees who took The Breakroom Quiz

90th of 113 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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