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Salaried Optum Health Coding Risk Adjustment Jobs in Georgia

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/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 ...

LCMC Health

LCMC Health includes two academic medical centers, a children's hospital, six community hospitals ... quality, risk adjustment, and reimbursement. * Oversee the physician query process, ensuring ...

Elevance Health

Coding Auditor Sr. (CareBridge)

Atlanta, GA · On-site

$26.25 - $29.75/hr

Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... American Health Information Management Association, American Academy of Professional Coders or ...

New

Elevance Health

Coding Auditor Sr. (CareBridge)

Atlanta, GA · On-site

$26.25 - $29.75/hr

Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... American Health Information Management Association, American Academy of Professional Coders or ...

New

Elevance Health

Coding Auditor Sr. (CareBridge)

Atlanta, GA

$26.25 - $29.75/hr

Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... American Health Information Management Association, American Academy of Professional Coders or ...

New

Emory Healthcare

CDCE Data Analyst

Atlanta, GA · On-site

At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits ... Risk adjustment trends * Patient Safety Indicators (PSI) and Hospital-Acquired Conditions (HAC)

Emory Healthcare

CDCE Data Analyst

Atlanta, GA · On-site

At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits ... Risk adjustment trends * Patient Safety Indicators (PSI) and Hospital-Acquired Conditions (HAC)

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Salaried Optum Health Coding Risk Adjustment information

What is a salaried Optum Health coding risk adjustment specialist?

A Salaried Optum Health Coding Risk Adjustment specialist is a healthcare professional employed by Optum Health who reviews medical records and codes diagnoses to ensure accurate risk adjustment. Their work supports proper reimbursement for Medicare Advantage and other risk-based health plans by identifying and coding chronic conditions and other relevant diagnoses. These specialists use their knowledge of ICD-10-CM coding guidelines and risk adjustment methodologies to improve documentation and compliance. Being salaried means they are full-time employees rather than contractors, which often includes benefits and consistent work schedules. Their efforts help ensure health plans are funded appropriately based on the health status of their members.

What are some common challenges faced by professionals in the salaried Optum Health coding risk adjustment role, and how can they be addressed?

One common challenge in the Salaried Optum Health Coding Risk Adjustment role is staying updated with frequent changes in coding guidelines, payer requirements, and risk adjustment models. Additionally, ensuring high accuracy while reviewing complex patient records under tight deadlines can be demanding. To address these challenges, professionals should engage in ongoing education, leverage available training resources provided by Optum, and actively participate in team knowledge-sharing sessions. Collaborating closely with clinical documentation specialists and auditing teams also helps maintain compliance and improve coding quality.

What are the key skills and qualifications needed to thrive as a salaried Optum Health coding risk adjustment specialist?

To excel as a Salaried Optum Health Coding Risk Adjustment specialist, you need a thorough understanding of ICD-10 coding, risk adjustment models, and healthcare compliance, typically supported by a coding certification such as CPC or CRC. Familiarity with electronic health record (EHR) systems, coding software, and data analytics tools is essential. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately interpreting clinical documentation and collaborating with healthcare teams. These competencies ensure accurate risk adjustment coding, regulatory compliance, and optimal reimbursement for healthcare organizations.

What is the difference between Salaried Optum Health Coding Risk Adjustment vs Medical Coder?

AspectSalaried Optum Health Coding Risk AdjustmentMedical Coder
CertificationsCPH, CCS, or RHIT often preferredCPH, CCS, or RHIT typically required
Work EnvironmentHealthcare organizations, insurance companies, remote optionsHospitals, clinics, outpatient facilities
Job FocusRisk adjustment coding, reimbursement accuracyClinical documentation, coding for billing
Industry UsageHigh in health insurance and managed careCommon in healthcare facilities

While both roles involve medical coding, Salaried Optum Health Coding Risk Adjustment specialists focus on risk adjustment coding to support insurance reimbursements, often working in managed care environments. Medical Coders typically handle clinical documentation coding for billing purposes in healthcare facilities. The roles share certifications and require strong coding skills but differ in their primary focus and work settings.

What are the most commonly searched types of Optum Health Coding Risk Adjustment jobs in Georgia? The most popular types of Optum Health Coding Risk Adjustment jobs in Georgia are:
What are popular job titles related to Salaried Optum Health Coding Risk Adjustment jobs in Georgia? For Salaried Optum Health Coding Risk Adjustment jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Salaried Optum Health Coding Risk Adjustment jobs in Georgia look for? The top searched job categories for Salaried Optum Health Coding Risk Adjustment jobs in Georgia are:
What cities in Georgia are hiring for Salaried Optum Health Coding Risk Adjustment jobs? Cities in Georgia with the most Salaried Optum Health Coding Risk Adjustment job openings:
Salaried Optum Health Coding Risk Adjustment jobs near you

Auditor, Risk Adjustment

Oscar Health

Atlanta, GA • Remote

$82K - $108K/yr

Full-time

Re-posted 9 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 303 rated insurance

Job description

Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Associate, Risk Adjustment Auditor conducts internal and external quality audits. Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

You will report into the Manager, Risk Adjustment.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
  • Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
  • Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
  • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
  • Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
  • Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
  • Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
  • Manage the implementation process improvements that will maximize risk adjustment factor increases.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Bachelor's degree in a relevant field of study or commensurate work experience.
  • Certified professional coder (CPC)
  • 3+ year(s) retrospective risk adjustment coding experience.
  • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Bonus points:

  • Certified Risk Adjustment Coder (CRC) or similar certification
  • Experience coding in a variety of different Electronic Medical Record (EMR) systems.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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