Senior Clinical Coding & Risk Adjustment Consultant

Optum; Orlando (FL); Hybrid; USD 73,000 - 130,000; Full time

Job summary

WellMed, part of the Optum family, seeks a Sr. Clinical Coding Nurse Consultant in Florida. The role drives Risk Adjustment programs, develops training, and partners with regional teams to improve HCC metrics.

The position requires RN licensure, CPC certification within 9 months, and 5+ years of nursing experience. Travel is required, and the role may be hybrid in Florida with a focus on data-driven performance improvements.

Qualifications

• Bachelor's Degree in Nursing required; RN license in good standing.
• CPC certification required or obtained within 9 months from date of hire.
• 5+ years of nursing experience in health care.
• At least 1 year of ICD-10 familiarity.
• Proven ability to influence changes in behavior.
• Knowledge of Medicare market, products, competitors.
• Willingness to travel locally and non-locally.
• TB screening and vaccination/immunity proof required.

Responsibilities

• Develop and implement market plans to engage providers in improving Risk Adjustment metrics.
• Analyze Risk Adjustment reporting including HCC metrics and fax-back data.
• Serve as SME for Risk Adjustment activities within assigned markets.
• Develop training and analytical materials for Risk Adjustment.
• Oversee DataRAP training for Mega Groups via provider sessions and JOCs.
• Lead regular Business Review meetings to summarize provider and market performance.
• Identify opportunities to improve provider group structure and operations.

Skills

Nursing experience

ICD-10 knowledge

Persuasion skills

Travel flexibility

Education

Bachelor's Degree in Nursing

Tools

CPC certification

Job description

WellMed, part of the Optum family, seeks a Sr. Clinical Coding Nurse Consultant in Florida. The role drives Risk Adjustment programs, develops training, and partners with regional teams to improve HCC metrics.

The position requires RN licensure, CPC certification within 9 months, and 5+ years of nursing experience. Travel is required, and the role may be hybrid in Florida with a focus on data-driven performance improvements.