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Optum Health Coding Risk Adjustment Jobs (NOW HIRING)

Mercor

HCC Coding Leader - Risk Adjustment

New York, NY · Remote

$110/hr

Background in health plan, Medicare Advantage organisation , or value-based care setting. * Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content

Centrum Health

Risk Adjustment Analyst

Doral, FL · On-site

SCOPE OF ROLE The Risk Adjustment and Analytics Team is working to push boundaries to redefine Risk ... Using SQL code, mine data on medical spend, clinical data and population health data and derive ...

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

As of Aug 6, 2026, the average hourly pay for optum health coding risk adjustment in the United States is $26.36, according to ZipRecruiter salary data. Most workers in this role earn between $21.63 and $29.57 per hour, depending on experience, location, and employer.

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.

What is an Optum Health Coding Risk Adjustment?

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?

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.

More about Optum Health Coding Risk Adjustment jobs
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Optum Health Coding Risk Adjustment jobs near you
Infographic showing various Optum Health Coding Risk Adjustment job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, and 10% Contract. Highlights an 52% In-person, and 48% Remote job distribution, with an average salary of $54,819 per year, or $26.4 per hour.

Medical Coder - Risk Adjustment Specialist

Volunteers of America National Services

Eden Prairie, MN • On-site

$58K - $66K/yr

Full-time

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

Volunteers Of America rating

6.9

Company rating: 6.9 out of 10

Based on 126 frontline employees who took The Breakroom Quiz

382nd of 767 rated non-profit organizations

Job description

Join Senior CommUnity Care as a Medical Coder - Risk Adjustment Specialist and partner directly with physicians and Medical Directors to improve documentation, support CMS reporting, and strengthen value-based care for older adults in the PACE program.
Medical Coder - Risk Adjustment Specialist- Remote
Schedule: M-F 8:00 AM-5:00 PM
Salary: $58,000-$66,000 (Based on Experience)
Essentials:
Collaboration for Risk Adjustment Integrity:
  • Works closely with Medical Directors and PACE providers to uphold the integrity and accuracy of the risk adjustment reporting process.
  • Engages in continuous dialogue with healthcare professionals to ensure that coding accurately reflects participant acuity.

Medication Documentation Review and Diagnostic Coding:
  • Reviews and interprets provider documentation to extract critical information.
  • Assigns ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures from documented information in the medical record.
  • Assures the final diagnoses and procedures are valid and complete.
  • Communicates and resolves coding issues (lacking documentation, provider queries, etc.).

Liaison Role:
  • Acts as a key intermediary between PACE providers and contracted coding services.
  • Ensures timely and effective response to coding-related inquiries and issues.

Coding Compliance and Data Analysis:
  • Facilitates the audit review process, collaborating with providers to resolve individual and systemic coding issues.
  • Leads efforts to enhance coding accuracy and compliance through regular, targeted audits.
  • Performs data analysis to uncover and seize missed coding opportunities.

Report Review and Response Process:
  • Works with clinical leadership to devise and implement procedures for generating and distributing participant specific-reports.
  • Ensures these reports are reviewed by the provider during subsequent participant clinic visits, maintaining a system for tracking and ensuring accountability.

Encounter Reporting Support:
  • Applies coding expertise to support the accuracy of the encounter reporting process in applicable programs. Acts as a resource for program leadership in determining the appropriateness of coding used for encounters.

Systems and Process Improvement:
  • Assists in the continuous improvement of systems and processes to better align with the organization's strategic goals.
  • Contributes to the development of initiatives that enhance the efficiency and accuracy of coding practices.

Remote Work and Accountability:
  • Work independently in remote setting, demonstrating high level of responsibility and accountability.
  • Collaborate with cross-functional teams as needed.

Establishes and maintains a productive working relationship.
  • Maintains the stability and reputation of SCC by ensuring all activities and operations are performed in compliance with local, State, and Federal laws, regulations and contractual requirements and adheres to organizational policies.
  • Is responsible for adherence to program cultural standards including supporting through modeling, coaching, and accountability.
  • Protects privacy and maintains confidentiality of all company procedures, results and information about employees, participants and families.
  • Participates in continuing education classes and any required staff and training meetings. Maintains professional affiliations and any required certifications.

Required Qualifications:
  • Education: Associate's degree in Health Information Management or related field.
  • Current certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) and Certified Risk Coder (CRC) required.
  • Experience: Minimum of five (5) years of experience working directly with diagnostic and procedural coding required. Strong preference for substantial experience with Hierarchical Condition Categories (HCCs) and risk adjustment methodologies.

Skills and Knowledge:
  • Ability to effectively communicate orally and in writing in English.
  • Strong technical skills with proficiency in data management.
  • Strong knowledge of medical terminology, anatomy and physiology, and disease processes.
  • Familiarity with healthcare software including EHR systems, coding software, and data analysis tools.
  • Understanding of regulatory requirements including HIPAA, CMS guidelines, AHIMA code of ethics, and other regulations affecting coding and billing.
  • Proficient ability with Excel including ability to extract meaningful information from large datasets.
  • Analytical skills and ability to interpret medical records and extract pertinent information for accurate coding.
  • Strong problem-solving and critical thinking skills.
  • Strong attention to detail.
  • Effective communication skills for presenting information.
  • Creative, detailed-oriented, and organized.
  • Must have integrity, practice discretion and practice objective problem solving.
  • Skilled in establishing and maintaining effective working relationships and working collaboratively with a multidisciplinary team.

At VOANS, we celebrate sharing, encouraging and embracing diversity. Equal employment opportunities are available to all without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, parental status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law. We believe that blending individual strengths and unique personal differences nurtures and supports our organizations' shared commitment to our mission and creates an inclusive and diverse environment where everyone feels valued and has the opportunity to do their personal best
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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