Risk Adjustment Coding Jobs for OPT Students
Risk Adjustment Coding jobs are a strong fit for F-1 OPT students with health information management, coding, or clinical informatics backgrounds. These roles are common at health plans and hospital systems that routinely sponsor H-1B visas, giving you a realistic path from OPT to long-term work authorization.
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Identifies, collects, assesses, monitors and documents ICD-10 diagnoses based coding information as it pertains to CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding compliance and consistency. Supports the creation, maintenance, and enhancement of clinical documentation accuracy in support of building a model of care focused on quality and health outcomes. Works internally to leverage clinical, coding, and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation. Assists healthcare providers to understand specific documentation topics as well as the issues facing healthcare providers to create buy-in. Alerts leadership of trends and irregularities evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC alerts addressed at DOS. Works under moderate supervision.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Conducts coding reviews independently on all medical record documentation to assign and/or audit the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology. Outreaches supervisor for non-routine issues and new situations.
- Responsible for ensuring completion of medical record reviews and related accurate score based on monthly target set forth by department.
- Keeps current on new coding and billing guidelines and federal and state initiatives regarding claims and educates other departments on new/changes to regulations.
- Regulatory Oversight and Quality Assurance and performs medical record compliance audits using the most up-to-date CMS guidelines, output generated is submitted to CMS to accurately capture member’s acuity resulting in a compliance and financial impact to the organization, maintains high level of quality and production standards required by leadership to ensure continued medical coding accuracy. This requires advanced knowledge, certifications, and experience related to coding/auditing of ICD 10 Diagnoses based on HCC category.
- Provides audit trail for all identified HCCs in a Medical Record Review through use of audit tool.
- Identifies all unsupported diagnoses/HCCs for all Risk Adjustment Data Validation (RADV) related projects and appropriately notifies management of deficiencies to report to Encounter submissions team.
- Provider Engagement, Audit, Training and Support and supports supervisor in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
- Reports incidental findings, patterns, and trends from audits/coding projects to supervisor thus assisting supervisor in analyzing audit results, tracking and trending. Responsible for supporting supervisor/manager for testing of Coding/Audit tool to ensure appropriate functioning, identifying trends, making recommendations for process improvement for ensuring compliance.
- Enterprise Wide Risk Adjustment Collaboration Activities and Initiatives and support Manager in driving enterprise-wide risk adjustment initiatives. Collaborates internally with Special Investigations and Compliance supporting medical record review and claims analysis for determination of provider engagement in fraud, waste and abuse. Provides guidance to claims team, SIU, and other teams related to ICD 10 Diagnoses codes, CPT and HCPCS codes related to Risk Adjustment in addition to identifying updates for all measures and contract billing codes, as necessary.
- Assists in identifying, developing and implementing Medicaid Risk Adjustment initiatives and activities for ensuring member’s acuity aligns with Risk Scores with accurate coding of CHA Assessments.
- Monitors Risk Scores for member’s/population, monitoring the dashboards for Utilization and Risk Scores, identifies any deviation in patterns and working leaders and analyst on identifies the root cause and implements an action plan.
- Collaborates with other departments on CHA assessment completion and accuracy.
- Assists in Audit activities of CHA Assessments at a frequency determined as per the workplan.
- Educates and monitors completion of any accompanying action items related to audits, such as trending/tracking of audit scores for improvement, reporting any abnormal findings or patterns to the leadership for development of action items and follow up on action items.
- Identifies ongoing possible discrepancies through review of CHA Assessments and reporting, sharing with assessors and monitoring for corrections if needed on an ongoing basis.
- Collaborates with education department in the development and implementation of Risk Adjustment related training programs.
- Collaborates with Assessment units and other teams to ensure compliance with CMS and DOH standards.
- Keeps informed of the latest internal and external issues and trends in Risk Score activities through networking, professional memberships in related organizations, DOH resources/websites and email updates.
- Assists in development, revisions and updating workflows and policies and procedures related to Risk Adjustment activities.
- Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
- Active Certified Coder Certification through AHIMA or AAPC required
Education
- Associate's Degree or equivalent work experience required
Work Experience
- Minimum two years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems required
- Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits required
- Additional years of experience/specialized certification/training may be considered in lieu of educational requirements required
- Knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures required
- Strong knowledge of claims processing procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications required
- Strong planning, organizational, interpersonal, verbal and written communication skills required
- Knowledge of HIPAA, understanding a commitment to Privacy, Security and Confidentiality of all medical chart documentation required
- Ability to work both in a fast-paced environment and/or be independently self-driven to complete day to day tasks required
- Ability to switch gears and independently collaborate with other departments for all ad lib projects as necessary required
Pay Range
USD $33.88 - USD $42.35 /Hr.
About us
VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
Overview
Identifies, collects, assesses, monitors and documents ICD-10 diagnoses based coding information as it pertains to CMS Hierarchical Condition Categories (HCC). Participates in and supports the Medicare Risk Adjustment team-based environment to educate providers on coding compliance and consistency. Supports the creation, maintenance, and enhancement of clinical documentation accuracy in support of building a model of care focused on quality and health outcomes. Works internally to leverage clinical, coding, and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation. Assists healthcare providers to understand specific documentation topics as well as the issues facing healthcare providers to create buy-in. Alerts leadership of trends and irregularities evidencing deviations from coding protocols. Conducts chart review around Provider Risk Adjustment Activity and clinical documentation errors around HCC alerts addressed at DOS. Works under moderate supervision.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Conducts coding reviews independently on all medical record documentation to assign and/or audit the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology. Outreaches supervisor for non-routine issues and new situations.
- Responsible for ensuring completion of medical record reviews and related accurate score based on monthly target set forth by department.
- Keeps current on new coding and billing guidelines and federal and state initiatives regarding claims and educates other departments on new/changes to regulations.
- Regulatory Oversight and Quality Assurance and performs medical record compliance audits using the most up-to-date CMS guidelines, output generated is submitted to CMS to accurately capture member’s acuity resulting in a compliance and financial impact to the organization, maintains high level of quality and production standards required by leadership to ensure continued medical coding accuracy. This requires advanced knowledge, certifications, and experience related to coding/auditing of ICD 10 Diagnoses based on HCC category.
- Provides audit trail for all identified HCCs in a Medical Record Review through use of audit tool.
- Identifies all unsupported diagnoses/HCCs for all Risk Adjustment Data Validation (RADV) related projects and appropriately notifies management of deficiencies to report to Encounter submissions team.
- Provider Engagement, Audit, Training and Support and supports supervisor in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
- Reports incidental findings, patterns, and trends from audits/coding projects to supervisor thus assisting supervisor in analyzing audit results, tracking and trending. Responsible for supporting supervisor/manager for testing of Coding/Audit tool to ensure appropriate functioning, identifying trends, making recommendations for process improvement for ensuring compliance.
- Enterprise Wide Risk Adjustment Collaboration Activities and Initiatives and support Manager in driving enterprise-wide risk adjustment initiatives. Collaborates internally with Special Investigations and Compliance supporting medical record review and claims analysis for determination of provider engagement in fraud, waste and abuse. Provides guidance to claims team, SIU, and other teams related to ICD 10 Diagnoses codes, CPT and HCPCS codes related to Risk Adjustment in addition to identifying updates for all measures and contract billing codes, as necessary.
- Assists in identifying, developing and implementing Medicaid Risk Adjustment initiatives and activities for ensuring member’s acuity aligns with Risk Scores with accurate coding of CHA Assessments.
- Monitors Risk Scores for member’s/population, monitoring the dashboards for Utilization and Risk Scores, identifies any deviation in patterns and working leaders and analyst on identifies the root cause and implements an action plan.
- Collaborates with other departments on CHA assessment completion and accuracy.
- Assists in Audit activities of CHA Assessments at a frequency determined as per the workplan.
- Educates and monitors completion of any accompanying action items related to audits, such as trending/tracking of audit scores for improvement, reporting any abnormal findings or patterns to the leadership for development of action items and follow up on action items.
- Identifies ongoing possible discrepancies through review of CHA Assessments and reporting, sharing with assessors and monitoring for corrections if needed on an ongoing basis.
- Collaborates with education department in the development and implementation of Risk Adjustment related training programs.
- Collaborates with Assessment units and other teams to ensure compliance with CMS and DOH standards.
- Keeps informed of the latest internal and external issues and trends in Risk Score activities through networking, professional memberships in related organizations, DOH resources/websites and email updates.
- Assists in development, revisions and updating workflows and policies and procedures related to Risk Adjustment activities.
- Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
- Active Certified Coder Certification through AHIMA or AAPC required
Education
- Associate's Degree or equivalent work experience required
Work Experience
- Minimum two years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems required
- Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits required
- Additional years of experience/specialized certification/training may be considered in lieu of educational requirements required
- Knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures required
- Strong knowledge of claims processing procedures and systems, State, Federal and Medicare Regulations and Coordination of Benefits applications required
- Strong planning, organizational, interpersonal, verbal and written communication skills required
- Knowledge of HIPAA, understanding a commitment to Privacy, Security and Confidentiality of all medical chart documentation required
- Ability to work both in a fast-paced environment and/or be independently self-driven to complete day to day tasks required
- Ability to switch gears and independently collaborate with other departments for all ad lib projects as necessary required
Pay Range
USD $33.88 - USD $42.35 /Hr.
About us
VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.
How to Get Visa Sponsorship in Risk Adjustment Coding
Target payers over providers
Health insurance companies and managed care organizations file far more H-1B petitions for risk adjustment coders than individual clinics or small practices. Focus your search on payers like regional health plans and large national insurers, which have dedicated coding teams and established sponsorship infrastructure.
Get your CRC or CCS credential before you apply
The Certified Risk Adjustment Coder credential from AAPC signals that you meet the technical bar employers expect. Holding it before your OPT starts strengthens your application and removes a common hesitation employers have about sponsoring candidates who still need training time.
Understand your OPT timeline before accepting a role
Standard OPT lasts 12 months. If your degree is in a STEM-qualifying field like health informatics, you may qualify for a 24-month STEM OPT extension. Clarify this with your DSO early so you can communicate your authorization window accurately to prospective employers.
Ask about remote coding roles explicitly
Risk adjustment coding is one of the most remote-friendly roles in healthcare IT. Many employers hire remote coders nationally, which widens your employer pool significantly. Remote availability also correlates with larger organizations that have formal immigration sponsorship programs already in place.
Connect your academic background to ICD-10-CM specificity
Employers want coders who understand hierarchical condition categories, not just basic diagnosis coding. In interviews, demonstrate familiarity with RAF score calculations and how accurate ICD-10-CM code selection affects risk scores. This technical depth signals you can contribute immediately without a long ramp-up period.
Search Migrate Mate to find OPT-friendly employers
Not every risk adjustment coding posting comes from an employer willing to sponsor OPT or future H-1B status. Migrate Mate filters for employers with a demonstrated sponsorship history, saving you time and helping you focus applications where your authorization is genuinely welcome.
Risk Adjustment Coding jobs are hiring across the US. Find yours.
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Get Access To All JobsFrequently Asked Questions
Can I work as a Risk Adjustment Coder on OPT?
Yes, as long as the role is directly related to your degree field. Health information management, health informatics, clinical coding, or a closely related healthcare or data program all qualify. Your DSO can confirm the connection for your specific degree. You must have an active EAD card before your start date and report the employer through your SEVIS portal within ten days of starting.
Does Risk Adjustment Coding qualify for STEM OPT extension?
It depends on your degree, not the job title itself. If you graduated from a STEM-designated program such as health informatics, biomedical informatics, or health data science, you may qualify for the 24-month extension. Coding degrees in non-STEM programs, such as health information technology from a community college, typically do not qualify. Check your program's CIP code with your DSO to confirm eligibility before accepting an offer.
How do I find Risk Adjustment Coding employers that sponsor visas?
Migrate Mate is built specifically for this. It surfaces risk adjustment coding roles from employers with documented H-1B sponsorship histories, so you are not wasting applications on companies that will not support your status long-term. Filtering by sponsorship track record is the most efficient way to focus your job search as an OPT student with a finite authorization window.
What happens to my OPT status if my risk adjustment coding job ends?
You enter a 60-day grace period from the date your employment ends. During that window, you can find a new qualifying position, change your status, or prepare to depart. You cannot work during the grace period. If your new role is with a different employer, you must update your employer information in SEVIS through your DSO before starting. Unemployment also counts toward a 90-day limit on your OPT period.
Do risk adjustment coding roles count as OPT-qualifying employment even if they are remote?
Yes. Remote work is fully permissible on OPT as long as the employer is a legitimate U.S. company and the role is directly related to your field of study. You must still report the employer's name, address, and your job title to your DSO within ten days of starting. The physical location of your work does not affect eligibility, but the employer's U.S. registration does.
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