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Salaried Optum Health Coding Risk Adjustment Jobs in Georgia

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)

Emory Healthcare

CDCE Data Analyst

Atlanta, GA

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

$52.37 - $65.06/hr

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)

Intermountain Health

PB Coding Supervisor

Atlanta, GA · On-site

$34.26 - $53.96/hr

Microsoft Office Suite products, Kronos, ServiceHub, Optum Encoder Pro, etc.). Skills * Medicare ... Intermountain Health is an equal opportunity employer. Qualified applicants will receive ...

Elevance Health

Systems Analyst Senior

Atlanta, GA · Hybrid

Knowledge of state regulatory requirements, financial reconciliations, audits, risk adjustment, rate setting, or healthcare reimbursement methodologies preferred. * Experience translating business ...

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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:
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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:
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Salaried Optum Health Coding Risk Adjustment jobs near you

Program Lead, Payor Connections/Interoperability

Oscar Health

Atlanta, GA • Remote

$91K - $120K/yr

Other

PTO

Re-posted 19 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 Program Lead, Payor Connections/Interoperability 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:

As a Program Lead, Payor Connections/Interoperability, you will be a key owner of an important interoperability initiative, the Program Lead will represent the needs and interests of the Risk Adjustment team. This new role is for you if you thrive with ambiguity and autonomy, and are comfortable building an end-to-end process! You will work with internal and external Oscar partners to ensure accurate acquisition of healthcare data from multiple provider systems.

You will report into the Director, Risk Adjustment Retrospective.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Lead interoperability projects with provider outreach
  • Develop relationships with provider group partners and vendors
  • Create and maintain project plans
  • Help develop operational strategy and market approach
  • Collaborate across the organization to identify actions to achieve improvements and monitor initiative impact
  • Direct the testing and validation of data connections to ensure compliance and functionality
  • Oversee the creation and maintenance of essential operational dashboards, and update and enhance them as our user's needs evolve
  • Track development progress, resolve issues related to data quality or integration, and ensure continuous improvement in interoperability programs
  • TEFCA subject matter expert
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • 3+ years of work experience in health care operations or health insurance; working directly with provider groups
  • 2+ years of experience in delivering interoperability projects / programs
  • In depth knowledge of TEFCA
  • Strong analytical skills

Bonus points:

  • Risk Adjustment experience
  • Basic SQL or BQ query writing experience

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