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Salaried Optum Health Coding Risk Adjustment Jobs in Kansas

WellSky

Data Analyst

Overland Park, KS · On-site

Comfort with healthcare claims coding structures (e.g., ICD, HCPCS/CPT, revenue codes, DRGs ... Familiarity with risk adjustment or benchmarking concepts. * Scripting experience (e.g., Python ...

WellSky

Data Analyst

Overland Park, KS

$2.5K/yr

Comfort with healthcare claims coding structures (e.g., ICD, HCPCS/CPT, revenue codes, DRGs ... Familiarity with risk adjustment or benchmarking concepts. * Scripting experience (e.g., Python ...

Parexel

Implement programming based on RWE protocols using a variety of RWD sources, including Optum and ... Familiarity with US and global healthcare coding systems (e.g., ICD, CPT, HCPCS, LOINC, MedDRA)

Highmark Health

Coder - Outpatient

Topeka, KS · On-site

$34.39/hr

Registered Health Information Associate (RHIA) * Certified Coding Specialist Physician (CCS-P ... The displayed salary range does not reflect any geographic differential Highmark may apply for ...

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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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Salaried Optum Health Coding Risk Adjustment jobs near you

Data Analyst

WellSky

Overland Park, KS • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 4 days ago

WellSky rating

7.3

Company rating: 7.3 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

181st of 245 rated software companies

Job description

The Data Analyst for Value-Based Insights (VBI) is responsible for transforming Medicare (CMS) claims data into metrics, benchmarks, and measures that power WellSky's VBI product for Home Health and Hospice providers and payers. This role builds and maintains claims-based data extracts and performance measures, translates CMS methodologies and regulatory rules into production analytics, and partners with product and engineering to deliver trusted, data-driven insights. The work is retrospective, methodology-driven, and directly tied to how agencies measure and improve value-based performance.
Key Responsibilities:
  • Build and maintain claims-based data extracts and measures from CMS data sources, including the Chronic Conditions Warehouse (CCW) and Limited Data Set (LDS), to support VBI Home Health and Hospice solutions.
  • Develop and maintain performance measures such as HHVBP claims-based measures, MSPB-PAC, Functional Items, hospitalization/ER/PPH/DTC rates, utilization and efficiency metrics, length of stay, and composite/percentile scores.
  • Interpret CMS regulations and annual Final Rules (e.g., HHVBP methodology, eTPS calculations) and translate measure specifications into accurate, reproducible SQL logic.
  • Write and optimize SQL against large claims datasets in BigQuery; contribute to data pipelines, quarterly lookup-table refreshes, and extract automation.
  • Produce referral pattern, competitive analysis, market/benchmark extracts, and validate outputs against CMS public benchmarks (e.g., Home Health Compare) and client expectations.
  • Investigate data quality issues and metric discrepancies, and document methodology, data sources, and assumptions so results are auditable and repeatable.
  • Prepare data for downstream BI/visualization layers (e.g., Sisense) and collaborate with product managers and engineers to define technical requirements and analytical interpretations.
  • Perform other job duties as assigned.

Required Qualifications:
  • Bachelor's degree in quantitative, health-informatics, or related field, or equivalent work experience.
  • 2-4 years of experience in data analysis, with demonstrated proficiency in SQL against large, complex datasets.
  • Direct experience working with Medicare/CMS claims data (e.g., CCW, LDS, LDS/RIF files, or comparable claims sources).
  • Comfort with healthcare claims coding structures (e.g., ICD, HCPCS/CPT, revenue codes, DRGs).
  • Ability to translate written specifications or methodologies into analytical logic and validate results for accuracy.

Preferred Qualifications:
  • Knowledge of Home Health and/or Hospice operations, post-acute care, or value-based care programs (e.g., HHVBP, HHVBP eTPS, hospice HIS/HOPE).
  • Experience with CMS quality/value-based program methodologies and familiarity with reading CMS regulations/Final Rules.
  • Hands-on experience with BigQuery (or a comparable cloud data warehouse such as Snowflake) and a BI tool such as Sisense, Tableau, or Power BI.
  • Familiarity with risk adjustment or benchmarking concepts.
  • Scripting experience (e.g., Python) for data transformation and automation.

Job Expectations:
  • Willing to work additional or irregular hours as needed, particularly around quarterly CMS data refreshes and annual Final Rule cycles.
  • Must work in accordance with applicable security and HIPAA policies to safeguard company and client protected health information.
  • Must be able to sit and view a computer screen for extended periods of time.

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WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.
WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace.
Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.
Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:
  • Excellent medical with Rx, dental, and vision benefits
  • Mental Health support through EAP
  • Generous paid time off, plus 13 paid holidays
  • 100% vested 401(K) retirement plans
  • Educational assistance up to $2500 per year

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