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Optum Health Coding Risk Adjustment Jobs (NOW HIRING)

Point32Health

Risk Adjustment Consultant

Canton, MA · On-site

Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated ... Support the Risk Adjustment department in efforts to assess additional diagnosis coding ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82.72K - $108.57K/yr

Oscar is the first health insurance company built around a full stack technology platform and a ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82.72K - $108.57K/yr

Oscar is the first health insurance company built around a full stack technology platform and a ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82.72K - $108.57K/yr

Oscar is the first health insurance company built around a full stack technology platform and a ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82.72K - $108.57K/yr

Oscar is the first health insurance company built around a full stack technology platform and a ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

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

As of Jun 4, 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 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
Infographic showing various Optum Health Coding Risk Adjustment job openings in the United States as of May 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 87% In-person, and 13% Remote job distribution, with an average salary of $54,819 per year, or $26.4 per hour.

Risk Adjustment Coding Specialist II - Houston, Texas

Astrana Health

Houston, TX • Remote

$70K - $85K/yr

Full-time

Posted 27 days ago

Job description

We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Beaumont market.  In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You'll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you'll track and report on key performance metrics-such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience! We are seeking candidates who reside in Houston and are able to travel to Beaumont on a monthly basis. 

Our Values: 
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
  • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) 
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines 
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
  • Other duties as assigned
  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification -  Certified Coding Specialist (CCS-P), CCS, or CPC.
  • 3-5+ years of experience in risk adjustment coding and/or billing experience required
  • Reliable transportation/Valid Driver's License/Must be able to travel up to 75% of work time
  • PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
  • Excellent presentation, verbal and written communication skills, and ability to collaborate 
  • Must possess the ability to educate and train provider office staff members
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.
You're great for this role if:    
  • Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
  • Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
  • Strong PowerPoint and public speaking experience
  • Ability to work independently and collaborate in a team setting
  • Experience with Monday.com
  • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting
  • The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
  • This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. This position requires monthly travel to Beaumont from Houston.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.    

Additional Information:     
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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