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Salaried Optum Health Coding Risk Adjustment Jobs in Riverside, CA

Alignment Healthcare

VP, Internal Audit

Orange, CA

Deepexpertisein Medicare Advantage plans, risk adjustment, and healthcare operations, including familiarity with CMS regulations, RADV, and the Model Audit Rule * Experience leading audit work in ...

Genesis10

Professional Consultant - Remote

Irvine, CA · On-site

$40 - $42/hr

... Risk Adjustment and CMS programs * Handson experience with CMS datasets (MMR, MOR, EDPS, Encounter data). Experience working with clinical, coding, or claims data in healthcare environments Only ...

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All JobsSalaried Optum Health Coding Risk Adjustment JobsSalaried Optum Health Coding Risk Adjustment Jobs in Riverside, CA

Salaried Optum Health Coding Risk Adjustment information

See Riverside, CA salary details

$36.5K

$63.3K

$94.4K

How much do salaried optum health coding risk adjustment jobs pay per year?

As of Jul 13, 2026, the average yearly pay for salaried optum health coding risk adjustment in Riverside, CA is $63,257.00, according to ZipRecruiter salary data. Most workers in this role earn between $50,100.00 and $76,200.00 per year, depending on experience, location, and employer.

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, and why are they important?

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 popular job titles related to Salaried Optum Health Coding Risk Adjustment jobs in Riverside, CA? For Salaried Optum Health Coding Risk Adjustment jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Salaried Optum Health Coding Risk Adjustment jobs in Riverside, CA look for? The top searched job categories for Salaried Optum Health Coding Risk Adjustment jobs in Riverside, CA are:
Salaried Optum Health Coding Risk Adjustment jobs near you
Infographic showing various Salaried Optum Health Coding Risk Adjustment job openings in Riverside, CA as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $63,257 per year, or $30.4 per hour.

Risk Adjustment Coding Specialist II - Orange County

Astrana Health, Inc.

Orange, CA • On-site

$70K - $85K/yr

Other

Posted 21 days ago

Job description

Risk Adjustment Coding Specialist II - Orange County
Department: Quality - Risk Adjustment
Employment Type: Full Time
Location: 600 City Parkway West 10th Floor, Orange, CA 92868
Reporting To: Yuvone Washington-Oshon
Compensation: $70,000 - $85,000 / year
Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Orange County market. In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You'll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you'll track and report on key performance metrics-such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
We are seeking candidates who have experience with provider education and at least 3-5 years of risk adjustment experience! This position requires travel to provider offices up to 75% of the time OC.
Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team
What You'll Do
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
  • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
  • Other duties as assigned
Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification - Certified Coding Specialist (CCS-P), CCS, or CPC.
  • At least 3 years of experience in risk adjustment coding and/or billing experience required
  • Reliable transportation/Valid Driver's License/Must be able to travel up to 75% of work time
  • PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
  • Excellent presentation, verbal and written communication skills, and ability to collaborate
  • Must possess the ability to educate and train provider office staff members
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.
You're great for this role if:
  • Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
  • Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
  • Strong PowerPoint and public speaking experience
  • Ability to work independently and collaborate in a team setting
  • Experience with Monday.com
  • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting
Environmental Job Requirements and Working Conditions
  • The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
  • This role follows a hybridwork structure where the expectation is to work on the field and at home on a weekly basis. This position requires up to 75% travel to provider offices in Orange County.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.comto request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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