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Optum Encoder Jobs in West Orange, NJ (NOW HIRING)

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Optum Encoder information

See West Orange, NJ salary details

$59

$81

$98

How much do optum encoder jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for optum encoder in West Orange, NJ is $81.40, according to ZipRecruiter salary data. Most workers in this role earn between $63.94 and $98.41 per hour, depending on experience, location, and employer.

What is an Optum Encoder?

Optum Encoders are specialized healthcare professionals who use Optum's medical coding software to accurately translate clinical documentation into standardized medical codes. These codes are used for billing, insurance claims, and maintaining patient records. Optum Encoders play a critical role in ensuring that healthcare providers receive proper reimbursement and comply with regulatory requirements. They must be knowledgeable about medical terminology, coding guidelines, and healthcare regulations. Their work helps streamline administrative processes and improve data quality in the healthcare industry.

What are the key skills and qualifications needed to thrive as an Optum Encoder?

To excel as an Optum Encoder, you need a solid understanding of medical coding systems (such as ICD-10, CPT, and HCPCS) and typically a certification like CPC or CCS. Familiarity with Optum’s 3M Encoder software, electronic health records (EHRs), and hospital information systems is also crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for ensuring coding accuracy and collaborating with clinical and billing teams. These abilities are important to ensure precise coding, regulatory compliance, and optimal reimbursement for healthcare services.

What are some common challenges faced by Optum Encoders when working with complex medical records?

Optum Encoders often encounter challenges such as interpreting incomplete or ambiguous clinical documentation, keeping up-to-date with evolving coding standards, and ensuring high levels of accuracy under tight deadlines. Collaboration with healthcare providers and coding auditors is frequently required to clarify information and resolve discrepancies. Staying detail-oriented and proactive in seeking clarification helps maintain compliance and reduce errors, while also providing opportunities to learn and grow in the role.

What is the difference between Optum Encoder vs Medical Coder?

AspectOptum EncoderMedical Coder
CertificationsTypically requires coding certifications like CPC or CCSOften requires CPC, CCS, or similar certifications
Work EnvironmentHealthcare facilities, insurance companies, remote optionsHospitals, clinics, insurance companies, remote work common
Industry UsageUsed mainly in healthcare and insurance sectorsWidely used across healthcare providers and insurance
Job ResponsibilitiesEncoding medical records for billing and documentationAssigning standardized codes to medical diagnoses and procedures

Both Optum Encoder and Medical Coder roles involve medical coding, often requiring similar certifications and working in healthcare environments. While Optum Encoder may be specific to Optum's systems and processes, Medical Coder is a broader role found across many healthcare organizations. Understanding these similarities helps in choosing the right career path or job search focus.

What are popular job titles related to Optum Encoder jobs in West Orange, NJ?

For Optum Encoder jobs in West Orange, NJ, the most frequently searched job titles are:

Optum Encoder jobs near you

Clinical Analyst & Coding Specialist - Contract - Columbia, SC

SUNSHINE ENTERPRISE USA LLC

Manhattan, NY • On-site

$90 - $120/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Clinical Analyst & Coding Specialist - Contract - Columbia, SC

Location: Columbia, SC Hybrid (80% remote, onsite for required trainings and meetings).

Duration: 12 months.

Employment Type: Contract.

Candidate location: Candidate MUST be an SC resident. No relocation allowed.

Seeking an experienced Business Analyst (Clinical Analyst & Coding Specialist) to support ongoing Medicaid operations and healthcare system initiatives. The consultant will serve as a Subject Matter Expert (SME) for medical coding, Medicaid policy, and business analysis while collaborating with business and technical teams to support coding updates, policy implementation, and business process improvements.

Key Responsibilities
  • Coordinate annual and quarterly ICD-10, CPT, and HCPCS code updates.
  • Review and analyze coding changes to determine business and operational impacts.
  • Prepare code change documentation for stakeholder review.
  • Collaborate with business users, stakeholders, and technical teams to implement coding and policy updates.
  • Participate in meetings related to healthcare systems modernization initiatives.
  • Serve as a Subject Matter Expert (SME) for medical coding methodologies and Medicaid-related processes.
  • Research business rules, requirements, and workflows to develop recommendations.
  • Maintain business rules, process documentation, and requirements repositories.
  • Support process documentation, knowledge transfer, and training activities.
  • Review medical records against established criteria to determine medical necessity when required.
  • Assist with additional healthcare and project-related initiatives.
Required Skills & Experience
  • 10+ years of experience in healthcare insurance, medical review, program integrity, or appeals.
  • 5+ years working with IT developers/programmers in a payer environment.
  • 5+ years of medical coding experience in a payer environment.
  • 3+ years of clinical experience in a healthcare environment.
  • Strong knowledge of ICD-10, CPT, and HCPCS coding methodologies.
  • Strong knowledge of anatomy, physiology, pharmacology, and medical terminology.
  • Experience gathering business requirements and documenting business processes.
  • Excellent analytical, communication, and stakeholder management skills.
Preferred Skills
  • Experience with healthcare policy remediation.
  • Claims processing systems experience.
  • Experience with Optum Encoder or other medical coding software.
  • Medicaid and healthcare payer systems experience.
  • Experience supporting healthcare system modernization initiatives.
Education

Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN).

Certification
  • Active, unrestricted Registered Nurse (RN) license.
  • Current CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification.
  • ICD-10 proficiency certification or ability to obtain certification within one year.

SUNSHINE ENTERPRISE USA LLC is an Equal Opportunity Employer and does not discriminate on the basis of race or ethnicity, religion, sex, national origin, age, veteran disability or genetic information or any other reason prohibited by law in employment.

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