ZipRecruiter

Log In

1

Optum Hcc Coding Jobs (NOW HIRING)

WhidbeyHealth

Coding Quality Auditor (RN)

Coupeville, WA · On-site

$95K - $133K/yr

Optum CAC (Computer-Assisted Coding) * TruCode Encoder * EPIC (in hybrid environments, as applicable) * Leverage system reporting tools to: * Identify coding and documentation trends * Monitor HCC ...

WhidbeyHealth

Coding Quality Auditor (RN)

Coupeville, WA

$26.50 - $30/hr

Optum CAC (Computer-Assisted Coding) * TruCode Encoder * EPIC (in hybrid environments, as applicable) * Leverage system reporting tools to: * Identify coding and documentation trends * Monitor HCC ...

Allmed Staffing Inc

Medical Coder

Minneapolis, MN · On-site

$21/hr

Telecommuter -- Optum FL950 (Remote) Work Hours: Full-time (40 hours/week), Monday-Friday, normal ... coding experience, preferably in Medicare Advantage, Risk Adjustment/HCC Coding * Coding ...

Optum - Tucson

NP - Family

Paradise Valley, AZ · On-site

$111K - $141K/yr

Knowledge of HEDIS measures, CAHPS, HOS, HCC Coding documentation * Proficient in Medicare Annual Wellness visits * Proficient in EMR systems & technology (EPIC Preferred) Client Details State AZ

next page

Showing results 1-20

All JobsHealthcare JobsHospital JobsMedical Coder JobsOptum Hcc Coding Jobs

Optum Hcc Coding information

See salary details

$9

$15

$26

How much do optum hcc coding jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for optum hcc coding in the United States is $15.39, according to ZipRecruiter salary data. Most workers in this role earn between $11.06 and $21.39 per hour, depending on experience, location, and employer.

What is an Optum HCC Coding?

An Optum HCC Coding job involves reviewing medical records to assign accurate Hierarchical Condition Category (HCC) codes, ensuring proper risk adjustment for healthcare providers. Coders analyze patient diagnoses using ICD-10-CM coding guidelines to support reimbursement accuracy and compliance with federal regulations. This role requires knowledge of risk adjustment models, medical terminology, and coding standards to enhance quality care and financial integrity in healthcare organizations.

What does an Optum HCC coder do?

As an Optum HCC Coder, your typical day involves reviewing patient medical records to ensure accurate capture of diagnoses that impact risk adjustment and reimbursement. You'll assign appropriate ICD-10-CM codes based on documentation, validate coding for completeness, and collaborate with healthcare providers to clarify any ambiguities. There may also be regular audits, meetings with clinical teams, and ongoing education to stay current with industry regulations. This routine supports organizational compliance and accurate data reporting, which are crucial for healthcare operations.

What are the key skills and qualifications needed for Optum HCC coding?

To thrive as an Optum HCC Coder, you need a strong understanding of medical coding standards, HCC (Hierarchical Condition Category) guidelines, and healthcare documentation, typically supported by a relevant certification such as CPC, CCS, or CRC. Proficiency with coding software systems like Epic or 3M and familiarity with ICD-10-CM codes are essential. Attention to detail, analytical thinking, and effective communication skills help ensure both accuracy and collaboration with healthcare providers. These competencies are crucial for optimizing risk adjustment, maintaining compliance, and supporting overall organizational goals.

Is Optum HCC coding a good career?

Optum HCC coding is a specialized role involving risk adjustment coding for healthcare reimbursement, requiring knowledge of medical coding and insurance guidelines. It offers opportunities for stable employment, remote work, and career advancement within healthcare administration. Success often depends on obtaining relevant certifications such as CPC or CCS and staying current with coding updates.
More about Optum Hcc Coding jobs

What cities are hiring for Optum Hcc Coding jobs?

Cities with the most Optum Hcc Coding job openings:

What are the most commonly searched types of Optum Hcc Coding jobs?

The most popular types of Optum Hcc Coding jobs are:

What states have the most Optum Hcc Coding jobs?

States with the most job openings for Optum Hcc Coding jobs include:

What job categories do people searching Optum Hcc Coding jobs look for?

The top searched job categories for Optum Hcc Coding jobs are:

Optum Hcc Coding jobs near you
Infographic showing various Optum Hcc Coding job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 1% As Needed, 82% Full Time, 11% Part Time, and 5% Contract. Highlights an 75% Physical, 5% Hybrid, and 20% Remote job distribution, with an average salary of $32,006 per year, or $15.4 per hour.

Coding Quality Auditor (RN)

Coupeville, WA • On-site

WhidbeyHealth
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about WhidbeyHealthexternal

$95K - $133K/yr

Full-time

Medical, Dental, Vision, Life

Posted 14 days ago

Job description

JOB SUMMARY
The RN, Coding Quality Auditor is a highly specialized, enterprise-critical role responsible for safeguarding the accuracy, integrity, and completeness of clinical documentation and coded data across inpatient and outpatient services.
This position plays a pivotal role in revenue integrity, regulatory compliance, and risk adjustment performance, with a strong focus on Hierarchical Condition Category (HCC) capture and Risk Adjustment Factor (RAF) optimization. Through comprehensive chart audits, the incumbent ensures that all diagnoses and procedures are captured with the highest level of specificity, fully supported by clinical documentation, and aligned with CMS and payer guidelines.
Leveraging advanced expertise in Meditech Expanse and leading coding technologies, this role translates clinical documentation into compliant, optimized coding outcomes that support both fee-for-service and value-based reimbursement models.
This role serves as a critical link between clinical operations, coding, and financial performance, driving accuracy in clinical representation while maximizing compliant reimbursement.
PRINCIPLE FUNCTIONS include the following, other duties may be assigned:
Coding Quality & Risk Adjustment Auditing
  • Conduct comprehensive audits of clinical documentation and coded data to ensure accurate assignment of:
    • ICD-10-CM/PCS
    • CPT and HCPCS
    • HCC classifications
  • Validate risk adjustment accuracy, ensuring appropriate capture, abstraction, and submission of HCCs
  • Verify diagnoses meet MEAT criteria (Monitor, Evaluate, Assess, Treat)
  • Ensure coding reflects the highest level of specificity and clinical accuracy
  • Identify and correct under-coding, over-coding, and documentation gaps impacting reimbursement

Systems & Technology Expertise
  • Demonstrates advanced proficiency in Meditech Expanse EHR, including:
    • Clinical documentation navigation
    • Abstracting workflows
    • Coding review processes
  • Utilize best-in-class coding and auditing technologies, including:
    • 3M Encoder / 360 Encompass
    • Optum CAC (Computer-Assisted Coding)
    • TruCode Encoder
    • EPIC (in hybrid environments, as applicable)
  • Leverage system reporting tools to:
    • Identify coding and documentation trends
    • Monitor HCC capture and RAF performance
    • Analyze denial patterns and revenue leakage
  • Partner with IT and system analysts to optimize:
    • Coding workflows
    • System edits and automation
    • Charge capture processes

Revenue Capture & Integrity
  • Ensure complete and accurate revenue capture for both facility and professional services, including RVU optimization
  • Identify missed revenue opportunities and gaps in documentation or coding
  • Drive measurable improvements in RAF accuracy and overall financial performance through targeted audit insights and interventions
  • Collaborate with RCM teams to reduce denials and prevent revenue leakage
  • Support reconciliation between clinical documentation, coding outputs, and billed data to ensure end-to-end revenue integrity

Compliance & Regulatory Oversight
  • Ensure adherence to CMS regulations, risk adjustment guidelines, and payer-specific requirements
  • Perform pre-bill and post-bill audits across care settings
  • Identify compliance risks and develop corrective action plans
  • Maintain audit readiness for external reviews (e.g., RADV, payer audits)

Provider Collaboration & Clinical Validation
  • Partner directly with providers to:
    • Clarify diagnoses
    • Validate clinical documentation
    • Close documentation gaps
  • Serve as a trusted advisor on documentation and risk adjustment requirements
  • Deliver clear, respectful, and actionable feedback to improve documentation quality
  • Align provider documentation with compliant coding and reporting standards

Education & Continuous Improvement
  • Develop and deliver targeted education for:
    • Providers
    • Coders
    • Revenue cycle staff
  • Translate audit findings into actionable training and performance improvement initiatives
  • Ensure stakeholders remain current on:
    • Coding guideline updates
    • Risk adjustment model changes
    • Payer policy updates

Audit Analytics & Performance Monitoring
  • Track and analyze key performance indicators, including:
    • Coding accuracy rates
    • HCC capture rates
    • RAF score impact
    • Coding- and documentation-related denial trends
  • Identify root causes of performance gaps and implement sustainable improvements
  • Provide data-driven insights and reporting to RCM leadership

JOB KNOWLEDGE & QUALIFICATIONS
Education
  • Graduate of an accredited school of nursing.
  • BSN preferred.

Training and Experience
  • 5+ years of progressive coding experience across inpatient and outpatient settings
  • Advanced expertise in risk adjustment (HCC coding and RAF methodologies)
  • Demonstrated experience in coding audits, compliance, and revenue integrity
  • Proven success improving coding accuracy and reimbursement outcomes
  • Experience collaborating with providers and clinical teams

Core Competencies
  • Advanced knowledge of risk adjustment models and reimbursement methodologies
  • Deep understanding of Meditech Expanse and EHR-driven workflows impacting coding and revenue
  • Ability to integrate clinical documentation, coding standards, and system functionality
  • Strong analytical, problem-solving, and data interpretation skills
  • Exceptional communication skills with ability to translate complex concepts clearly
  • High attention to detail and commitment to compliance and integrity
  • Collaborative, solutions-oriented mindset

Preferred Attributes
  • Experience supporting Medicare Advantage and other major payer programs, including value-based care models, with strong understanding of risk-adjusted reimbursement, HCC coding, and RAF optimization
  • Background in denial prevention and appeals related to coding/documentation
  • Familiarity with Clinical Documentation Integrity (CDI) programs
  • Ability to influence provider engagement through education and data

Certificates, Licenses, Registrations
  • Active WA State RN License or Active Multistate License (MSL)
  • MSL Requirements:
    • Approved 6-Hour Suicide Prevention Training Course Completion
    • Screenshot of submitted demographic data using the Washington State Multistate Nurse Demographic Data Survey.
  • Required certification (one or more):
    • CCS, CPC, CRC, RHIT, or RHIA
    • CRC strongly preferred (risk adjustment focus)

Health & Well-Being You Can Count On
We offer a thoughtful, comprehensive benefits package designed to support you and your family at every stage of life:
  • Medical Coverage - HDHP w/HSA / PPO
  • Prescription Drug Coverage
  • Dental Options - PPO / Managed-Care Plan
  • Vision Benefits - VSP
  • Life & AD&D Insurance - Employer paid coverage
  • Long-Term Disability Coverage - Employer paid income Protection
  • Health Savings Account (HSA) - If enrolled in HDHP
  • Healthcare Flexible Spending Account (FSA) - Dependent & Healthcare
  • Employee & Provider Assistance Programs - Free, confidential support
  • Voluntary Life & AD&D Insurance - Additional employee paid buy up option
  • Voluntary Long-Term Disability Coverage - Additional employee paid buy up option

Apply