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Salaried Optum Health Coding Risk Adjustment Jobs

Mercor

HCC Coding Leader - Risk Adjustment

New York, NY · Remote

$110/hr

Background in health plan, Medicare Advantage organisation , or value-based care setting. * Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content

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Salaried Optum Health Coding Risk Adjustment information

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$35K

$60.6K

$90.5K

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

As of Aug 23, 2026, the average yearly pay for salaried optum health coding risk adjustment in the United States is $60,634.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,000.00 and $73,000.00 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 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
Infographic showing various Salaried Optum Health Coding Risk Adjustment job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 76% Full Time, 16% Part Time, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $60,634 per year, or $29.2 per hour.

Risk Adjustment Coding Specialist II

Astrana Health, Inc.

Monterey Park, CA • Hybrid

$75K - $85K/yr

Full-time

Posted 13 days ago

Job description

Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to the Supervisor - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects.
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 retrospective 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 
  • Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned 
  • 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. 
  • Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success. 
  • 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 

Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required
  • 3+ years experience in risk adjustment coding required. Billing experience is a plus. 
  • Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time 
  • PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint
  • 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 the role if: 
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage 
  • Ability to work independently and collaborate in a team setting 
  • Strong organizational and time-management skills 
  • Ability to work in a home office for continuous periods of time for business continuity 
  • Ability to travel across the Provider Clinic service region for meetings and/or training as needed 
  • Able to work independently and within time constraints
  • Able to efficiently prioritize multiple high-priority tasks

Environmental Job Requirements and Working Conditions
  • This position blends on-site fieldwork (approximately 75% travel) with hybrid support to help practices. The Company reserves the right to modify the work arrangement, including transitioning to a hybrid or onsite model, based on business needs. Disclaimer: This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, or qualifications required. Responsibilities may change based on business needs and organizational priorities.
  • The national target pay range for this role is $75,000 - $85,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
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.com to 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.