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Salaried Optum Health Coding Risk Adjustment Jobs in Georgia

Enlace Health

Senior Medical Economics Analyst

Atlanta, GA · On-site

$84K - $112K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

CMS revenue and risk adjustment data * Value-based performance datasets * Strong proficiency in SQL ... Enlace Health offers competitive benefits and perks to all our employees! Our comprehensive ...

Enlace Health

Senior Medical Economics Analyst

Atlanta, GA · On-site

$84K - $112K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

CMS revenue and risk adjustment data * Value-based performance datasets * Strong proficiency in SQL ... Enlace Health offers competitive benefits and perks to all our employees! Our comprehensive ...

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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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For Salaried Optum Health Coding Risk Adjustment jobs in Georgia, the most frequently searched job titles are:

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Salaried Optum Health Coding Risk Adjustment jobs near you

Senior Medical Economics Analyst

Enlace Health

Atlanta, GA • On-site

$84K - $112K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 12 days ago

Job description

Senior Medical Economics Analyst
Enlace Health is a specialty value-based care company focused on reducing the cost of care where it matters most: specialty services. Enlace operates across 80+ markets, delivering measurable results including millions in savings and improved care coordination. Our platform embeds actionable intelligence into real-world execution, helping payors lower medical loss ratios and drive sustainable financial performance.
At Enlace Health, our people are our greatest asset. Our culture is founded upon integrity, hard work, and the relentless pursuit to make a difference. We think creatively, we like a challenge and draw inspiration from each other. As the Senior Medical Economics Analyst, you'll have deep expertise in actuarial methods, value-based payment modeling, predictive analytics, and medical cost economics. This role will support the design, evaluation, and optimization of value-based pricing and performance frameworks across Commercial, Medicare (including Medicare Advantage), and Medicaid populations.
Success Measures:
  • In 3 months:
    • Gain full command of data and methodologies.
    • Deliver early validated insights that build stakeholder confidence.

In 6 months:
    • Translate analytics into actionable financial and clinical insights.
    • Own development of methodologies for program evaluation, performance normalization, and predictive insights.

In 12 months:
    • Architect scalable value-based pricing and performance frameworks.
    • Inform network, contracting, clinical, and financial decisions with advanced analytics.
    • Demonstrate measurable enterprise impact on cost, quality, and risk performance.

Responsibilities:
  • Support pricing validation, reconciliation modeling, and performance evaluation analyses
  • Construct prospective and retrospective target-setting methodologies using difference-in-differences approaches, market benchmarking, credibility weighting, and risk-adjusted baselines
  • Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business
  • Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation
  • Support steerage, network optimization, and care management analytics
  • Perform medical cost trend decomposition (unit cost vs. utilization vs. intensity vs. mix)
  • Conduct risk-adjusted PMPM analysis across specialties, site-of-service, and population segments
  • Analyze longitudinal performance across defined assessment periods
  • Quantify impact of specialty utilization patterns and referral dynamics
  • Evaluating acuity, case-mix, and coding impacts across populations
  • Write advanced SQL queries to construct episode-level, provider-level, and member-month datasets

Position Requirements:
  • Bachelor's degree in a STEM field, with Master's degree preferred, or equivalent work experience
  • 5+ years of experience working within a payer or provider organization, or with healthcare analytics or care management organizations
  • Demonstrated experience across Commercial, Medicare (including MA), and Medicaid populations
  • Deep experience working the following types of data:
    • Medical claims data
    • Enrollment and eligibility data
    • Provider data
    • CMS revenue and risk adjustment data
    • Value-based performance datasets
  • Strong proficiency in SQL, Tableau, and Excel
  • Experience utilizing Python or R is a plus

Position Perks:
Enlace Health offers competitive benefits and perks to all our employees! Our comprehensive benefits package is one of the many ways we show our employees how valued they are. All full-time employees are eligible for the following:
  • FREE medical, dental, and vision insurance for employees on select plans
  • $1740 annual contribution into qualifying HSAs
  • UNLIMITED time off
  • Matching 401(k) plan
  • Mac laptop and accessories
  • Company-paid short-term and long-term disability
  • Company-paid life insurance
  • Employee Assistance Program
  • Annual professional development stipend

All employees are required to maintain confidentiality as related to patient information. Employees are required to follow the acceptable use policy while using any information systems owned or controlled by Enlace. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense. Security roles and responsibilities include:
  • Implementing and acting in accordance with the organization's information security policies
  • Protecting assets from unauthorized access, disclosure, modification, destruction, or interference
  • Executing particular security processes or activities
  • Ensuring responsibility is assigned to the individual for actions taken
  • Reporting security events or potential events or other security risks to the organization

The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. The requirements listed above are representative of the minimum knowledge, skill, and/or ability required. To perform this job successfully, an individual must be able to satisfactorily perform the essential functions of the job according to specific company requirements. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions. Qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, disability, or marital status. Applicants must be legally authorized to work in the US.

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