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Optum Health Coding Risk Adjustment Jobs in Ohio

Aledade

Clinical Risk Educator, Remote

Cincinnati, OH · On-site

Bachelor's degree in a healthcare related field or equivalent work experience required * 5+ years ... Risk Adjustment Coder (CRC), Certified Clinical Documentation Specialist (CCDS), Certified ...

Reveleer

Applied Analytics Intern

New Albany, OH · On-site

$25/hr

... coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data ... Reveleer partners with health plans to power value-based care and risk adjustment programs through ...

Reveleer

Applied Analytics Intern

New Albany, OH · On-site

$25/hr

... coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data ... Reveleer partners with health plans to power value-based care and risk adjustment programs through ...

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

As of Jun 1, 2026, the average hourly pay for optum health coding risk adjustment in Ohio is $25.06, according to ZipRecruiter salary data. Most workers in this role earn between $20.58 and $28.12 per hour, depending on experience, location, and employer.

What is an Optum Health Coding Risk Adjustment job?

An Optum Health Coding Risk Adjustment job involves reviewing medical records to assign appropriate diagnosis codes that impact risk adjustment programs. These coders ensure accurate documentation of chronic conditions to support healthcare reimbursement models. They work with providers to improve coding accuracy and compliance with regulatory guidelines. Strong knowledge of ICD-10-CM coding, risk adjustment models, and healthcare regulations is essential.

What are the key skills and qualifications needed to thrive in the Optum Health Coding Risk Adjustment position, and why are they important?

To thrive as an Optum Health Coding Risk Adjustment professional, you need a strong understanding of ICD-10-CM coding, risk adjustment methodologies, and medical terminology, often supported by certifications like CPC, CRC, or CCS-P. Familiarity with electronic medical record (EMR) systems, coding software, and compliance tools is essential. Attention to detail, analytical thinking, and effective communication are valuable soft skills in this role. These competencies ensure accurate coding, regulatory compliance, and optimal risk adjustment, directly impacting healthcare quality and reimbursement.

What are the typical daily responsibilities of an Optum Health Coding Risk Adjustment specialist?

On a daily basis, Optum Health Coding Risk Adjustment specialists review medical records to identify and accurately code diagnoses, ensuring completeness and compliance with risk adjustment requirements. They collaborate closely with clinical teams and other coders to clarify documentation and resolve discrepancies. The role often involves conducting chart audits, submitting coding queries, and staying updated on the latest coding guidelines and regulatory changes. Attention to deadlines and maintaining data quality are key parts of the job, making it both detail-oriented and highly collaborative.
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Optum Health Coding Risk Adjustment jobs near you
Risk Adjustment Coder - Risk Management

Risk Adjustment Coder - Risk Management

Kettering Health

Kettering, OH • On-site

Full-time

Posted 6 days ago

Kettering Health rating

7.3

Company rating: 7.3 out of 10

Based on 182 frontline employees who took The Breakroom Quiz

289th of 864 rated healthcare providers

Job description

Incentives

Physician Office | Kettering | Full-Time | First Shift

Overview

Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God's love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.

Responsibilities & Requirements

Responsibilities & Requirements

This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. 

KPN Pro Fee Coding Specialist

Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines.

  • Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits
  • Reviewing the ambulatory records for the appropriate risk adjustment components
  • Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes
  • Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10
  • Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy]
  • Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits
  • Corresponds with providers on pending claims to facilitate resolution
  • Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies
  • Communicate appropriately with providers, leaders, and staff
  • Researches and resolves concerns timely

The Risk Adjustment Coder is responsible for coding and abstracting all outpatient patient records using ICD-10-CM and CPT/HCPCS coding rules, federal guideline and KMCN guidelines. Additionally, the Risk Adjustment Coder supports hospital's accounts receivable goals through timely processing of records and physician record completion activities. Impacts delivery of quality patient care and enhanced clinical decision-making process. Supports clinical outcomes measurement and assessment process for service lines. Completes assigned duties and other related tasks. The list is not inclusive, Performs other duties as assigned.

 The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records.  The Risk Adjustment Coder will contribute to overarching educational efforts of the MSO regarding Risk Adjustment.  The Risk Adjustment Coder will offer summarized content, feedback from providers, key barriers or success efforts to executive leaders to assist in the overall risk adjustment of the population. 

The Risk Adjustment Coder will spend some in-person time with providers to foster a relationship and encourage dialogue with risk adjustment to improve overall outcomes. The Risk Adjustment Coder will develop a collegial relationship with the Clinical Documentation Specialist RN (CDS) to partner on the overarching risk adjustment of the population.

Educational Requirements:

High School Diploma or equivalent

RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification

Prior experience in professional fee coding/billing

CRC required within 1 year of hire

Employment Type: FULL_TIME

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