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Salaried Optum Health Coding Risk Adjustment Jobs in Kansas

Resources of Kenya

Project Manager

Kansas City, KS · On-site

Company Description Our client is an international Healthcare AI company that specializes in ... In terms of skills, they are looking for experts in risk adjustment coding, MLOps engineering ...

Intermountain Health

PB Coding Coordinator

Topeka, KS · On-site

$31.01 - $48.84/hr

Functionally work within Microsoft Office Suite products & Optum Encoder Pro. * Provides education ... Promotes mission, vision, and values of Intermountain Health, and abides by service behavior ...

LMH Health

Medical Coding Auditor

Lawrence, KS · On-site

At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that ... Perform organizational compliance risk assessments to identify strengths, vulnerabilities, and ...

Intermountain Health

PB Coder

Topeka, KS · On-site

$28.06 - $44.20/hr

Evaluates and resolves all types of coding edits in assigned Charge Review, Claim Edit, and ... Microsoft Office Suite products, Kronos, ServiceHub, Optum Encoder Pro, etc.). * Meets or exceeds ...

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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 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 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 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.

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

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Salaried Optum Health Coding Risk Adjustment jobs near you

Risk Adjustment Quality Specialist

LMH Health

Lawrence, KS • On-site

Full-time

Re-posted 16 days ago

Job description

Something special starts here.
You can't define it, but you know it when you see it: the difference between an average life and the good life. When your cup is full - with joy, purpose and lifelong health - it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you're looking for at LMH Health.
You'll find everything you're looking for at LMH Health:
  • Join a team that cares about the community
  • Tuition reimbursement to support continuing education
  • Professional development and recognition
  • Excellent benefits

We're looking for you.
Job Description
I. JOB SUMMARY
The Risk Adjustment Quality Specialist plays a vital role in coordinating and supporting prospective, concurrent, and retrospective reviews to assist with patient care management. The position provides education and facilitates chart retrieval for Health Plan audits and reports. This position requires a comprehensive understanding of Hierarchical Condition Categories (HCC) coding to accurately translate, input, extract, and validate medical record data.
This role assists with monitoring quality program performance, including tracking, reporting, and implementation of best practices and program requirements.
II. ESSENTIAL JOB RESPONSIBILITIES
  • Perform comprehensive reviews of patient medical records for documentation consistency and adequacy to identify all appropriate coding based on Centers for Medicare & Medicaid Services (CMS) HCC categories.
  • Monitor revenue opportunities related to value-based care.
  • Manage the provider query process to clarify documentation and ensure the completeness and accuracy of patient diagnoses, particularly related to chronic conditions.
  • Utilize evidence based practices to provide providers with targeted feedback and education on improving documentation and coding accuracy, specifically related to HCC.
  • Demonstrate analytical and problem-solving ability with regard to barriers in receiving and validating accurate HCC information.
  • Analyze performance data to identify trends, gaps, and opportunities for improvement.
  • Maintains intermediate to advanced understanding of claims processing procedures, state and federal regulations, and Medicare Part D requirements.
  • Utilize coding software to ensure compliance with Medicare, Medicaid, and other payer requirements.
  • Collaborate with medical staff to clarify documentation and support accurate coding and reimbursement.
  • Participate in audits, quality reviews, and continuous improvement initiatives.
  • Educate staff on coding practices and HCC assignments.
  • Maintain compliance with policies, procedures, and continuing education requirements.
  • Performs other duties as needed or assigned.

III. JOB QUALIFICATIONS
Required:
  • Minimum of 3 years of experience in medical coding or risk adjustment with a focus on Hierarchical Care Conditions, value based care contracts, and accountable care organizations.
  • Strong knowledge of CMS risk adjustment and quality initiatives, including Hierarchical Condition Categories (HCCs).
  • Completion of one of the following through AHIMA accredited programs: Certificate Coding Associate, Certificate Coding Specialist, Certified Professional Coder, Registered Health Information Technician, Registered Health Information Administrator
    OR
  • Credentialed through AAPC

Preferred:
  • Registered Nurse
  • Associates or Bachelor's Degree in Health Information Management
  • 3M Coding Solution Knowledge

Remote Work/Work-from-Home:
This position has hybrid work flexibility. This person must live within Kansas or Missouri, and will be required attend on-site meetings, as scheduled.
Our Cultural Beliefs
  • People First
  • Integrity Matters
  • Better Together

At LMH Health, we value inclusion and diversity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

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