Medicare Risk Adjustment Coding Consultant - Remote within San Diego, CA Area

Company: Optum
Location: San Diego
Posted on: May 20, 2025

Job Description:

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
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You will be in the field consulting with providers approximately 4 days per week and the other 1 day will be working from home. This is a Monday - Friday position. Candidates must reside in San Diego or the surrounding area.
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This position requires travel up to 75% within the state. Relocation is not provided for this position.
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If you are located in San Diego, CA, you will have the flexibility to work remotely* as you take on some tough challenges.
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Primary Responsibilities:

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• Partners with Healthcare Advocates in the field and will be assigned providers to embed based on data analysis where they need support / training on improving documentation and coding accuracy
  
• Utilizes analytics to identify and target providers for Medicare Risk Adjustment training and documentation/coding resources
  
• The Medicare Risk Adjustment Coding Consultant will be responsible for facilitating and/or performing an audit of the providers' medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately
  
• Assist providers in understanding quality and CMS-HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding
  
• Supports the providers by ensuring documentation supports the submission of relevant ICD-10-CM codes in accordance with national coding guidelines and appropriate reimbursement requirements
  
• Routinely consults with medical providers to clarify missing or inadequate record information and to determine
  appropriate diagnostic and procedure codes
  
• Ensures member encounter data (services and disease conditions) is being accurately documented and all relevant diagnosis codes are captured
  
• Provides customized documentation improvement education, including corresponding ICD-10-CM codes to providers and appropriate staff -
  
• Develops and presents documenting & coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs
  
• Educates providers and staff on documentation & coding guidelines and changes as it relates to Quality and Risk Adjustment to ensure compliance with state and federal regulations
  
• Performs chart note analysis and provides timely feedback to providers on a regularly scheduled basis
  
• Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding best practices
  
• Reviews selected medical documentation to determine if assigned diagnosis and procedures codes are appropriately assigned
  
• Collaborates with doctors, coders, facility staff and a variety of internal and external personnel on a wide scope of Risk Adjustment and Quality education efforts
  
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  You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:
  
  
  Certified Professional Coder (CPC) certification and/or Certified Risk Adjustment Coder
  4+ years of experience with physician billing and/or coding
  Experience in CMS-HCC Risk Adjustment
  Experience managing/maintaining relationships with physicians/ hospitals/ health systems
  Ability to work effectively with common office software, coding software, EMR and abstracting systems
  Proficient in MS Word, Excel, PowerPoint and Outlook
  Ability to travel within state up to 75% to client locations
  Reside in San Diego, CA or are willing to relocate to the area without relocation assistance
  
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  Preferred Qualifications:
  

  
  CPC-I and/or CPMA certifications from AAPC
  4+ years of clinic or hospital and/or managed care experience
  Experience in a leadership position in a physician practice
  Proven knowledge of billing/claims submission and other related actions
  Proven solid communication and presentation skills
  Proven relationship building skills with clinical and non-clinical personnel
  
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  *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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  The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
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  At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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  UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
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  UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, Aliso Viejo , Medicare Risk Adjustment Coding Consultant - Remote within San Diego, CA Area, Professions , San Diego, California