Risk Adjustment Coding Jobs in USA with Visa Sponsorship
Risk adjustment coding roles attract strong H-1B visa and green card sponsorship from health plans, managed care organizations, and risk-bearing provider groups. Employers routinely sponsor CRC-credentialed coders, with specialty occupation status supported by healthcare administration or health information management degrees. For detailed occupation requirements, see the O*NET profile.
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Get Access To All JobsINTRODUCTION
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
If you are located in Houston, Texas and have the ability to go to office for meetings / etc., you will have the flexibility to work remotely* as you take on some tough challenges.
PRIMARY RESPONSIBILITIES:
- 45% Claims Review & Adjustment:
- Review claims requiring correction due to processing errors, updated documentation, or system changes
- Analyze claim history, benefit plans, and prior adjudication to determine appropriate adjustments
- Perform claim corrections, reversals, and reprocessing in accordance with internal policies and regulatory guidelines
- Validate accurate payment or denial outcomes following adjustments
- 25% Investigation & Resolution:
- Investigate discrepancies, missing information, or inconsistencies impacting claim outcomes
- Ensure all actions are clearly documented within the claims system
- Provide clear, accurate explanations regarding adjustment decisions when required
- Investigate Data Mining results for potential recovery adjustments
- 15% Cross-Functional Collaboration:
- Partner with Claims Processing, Quality Assurance, Training, Escalations, Customer Service, and Appeals teams to resolve issues
- Support escalated or complex claim scenarios requiring coordination across departments
- 10% Quality & Process Improvement:
- Identify trends, root causes, and recurring issues contributing to preventable errors
- Provide feedback and recommendations to improve first-pass claim accuracy and operational efficiency
- 5% Other:
- Participate in department initiatives and special projects as assigned by leadership
- Provide subject matter expertise for training, process improvements, and system enhancements
- Support cross-functional collaboration with Claims, Regulatory, Quality, and Audit teams to achieve departmental goals
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:
- High School Diploma or GED
- 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment
- Working knowledge of claim adjudication workflows and benefit interpretation
- Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and spreadsheet tracking
- Proven excellent written and verbal communication skills
- Proven ability to interpret claim data, supporting documentation, and payer requirements
- Proven ability to work independently while managing multiple priorities
- Demonstrated solid attention to detail with the ability to ensure accuracy and completeness of work
- Demonstrated solid documentation and organizational skills
- Demonstrated professionalism, accountability, and compliance mindset
PREFERRED QUALIFICATIONS:
- Experience specifically in claims adjustments, retro-processing, or complex claim review
- Experience with claims systems such as EPIC, Centricity, or similar platforms
- Experience participating in audit readiness, QA reviews, or error-prevention initiatives
- Familiarity with HIPAA requirements, state mandates, and payer-specific rules
- Prior collaboration with Quality, Training, or Audit teams
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
COMPENSATION
- Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20 - $36 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.
OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
INTRODUCTION
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
If you are located in Houston, Texas and have the ability to go to office for meetings / etc., you will have the flexibility to work remotely* as you take on some tough challenges.
PRIMARY RESPONSIBILITIES:
- 45% Claims Review & Adjustment:
- Review claims requiring correction due to processing errors, updated documentation, or system changes
- Analyze claim history, benefit plans, and prior adjudication to determine appropriate adjustments
- Perform claim corrections, reversals, and reprocessing in accordance with internal policies and regulatory guidelines
- Validate accurate payment or denial outcomes following adjustments
- 25% Investigation & Resolution:
- Investigate discrepancies, missing information, or inconsistencies impacting claim outcomes
- Ensure all actions are clearly documented within the claims system
- Provide clear, accurate explanations regarding adjustment decisions when required
- Investigate Data Mining results for potential recovery adjustments
- 15% Cross-Functional Collaboration:
- Partner with Claims Processing, Quality Assurance, Training, Escalations, Customer Service, and Appeals teams to resolve issues
- Support escalated or complex claim scenarios requiring coordination across departments
- 10% Quality & Process Improvement:
- Identify trends, root causes, and recurring issues contributing to preventable errors
- Provide feedback and recommendations to improve first-pass claim accuracy and operational efficiency
- 5% Other:
- Participate in department initiatives and special projects as assigned by leadership
- Provide subject matter expertise for training, process improvements, and system enhancements
- Support cross-functional collaboration with Claims, Regulatory, Quality, and Audit teams to achieve departmental goals
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:
- High School Diploma or GED
- 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment
- Working knowledge of claim adjudication workflows and benefit interpretation
- Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and spreadsheet tracking
- Proven excellent written and verbal communication skills
- Proven ability to interpret claim data, supporting documentation, and payer requirements
- Proven ability to work independently while managing multiple priorities
- Demonstrated solid attention to detail with the ability to ensure accuracy and completeness of work
- Demonstrated solid documentation and organizational skills
- Demonstrated professionalism, accountability, and compliance mindset
PREFERRED QUALIFICATIONS:
- Experience specifically in claims adjustments, retro-processing, or complex claim review
- Experience with claims systems such as EPIC, Centricity, or similar platforms
- Experience participating in audit readiness, QA reviews, or error-prevention initiatives
- Familiarity with HIPAA requirements, state mandates, and payer-specific rules
- Prior collaboration with Quality, Training, or Audit teams
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
COMPENSATION
- Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20 - $36 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.
OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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Get Access To All JobsTips for Finding Risk Adjustment Coding Jobs
Target managed care and health plan employers
Large health plans and Medicare Advantage organizations file the most LCAs for risk adjustment coding roles. These employers have established immigration programs and legal infrastructure, making sponsorship significantly more straightforward than smaller outpatient clinics or independent practices.
Earn your CRC or CCS credential before applying
The Certified Risk Adjustment Coder credential from AAPC signals specialty-level expertise to both employers and USCIS. Credentialed candidates face far less resistance on specialty occupation determinations because the credential reinforces that the role requires specialized knowledge beyond general coding.
Frame your degree against the specialty occupation standard
USCIS scrutinizes whether risk adjustment coding genuinely requires a bachelor's degree. Degrees in health information management, healthcare administration, or biology strengthen your petition considerably. Pair your degree with CRC certification to build the most defensible specialty occupation argument.
Ask about cap-exempt or cap-subject H-1B filing early
If your prospective employer is a nonprofit hospital system or university-affiliated health plan, you may qualify for cap-exempt H-1B filing year-round. Confirm the employer's cap status before the April lottery window closes so you're not waiting an additional year.
Negotiate an employment start date that accounts for processing
Standard H-1B processing runs three to five months. If you're changing employers or entering from outside the U.S., build that buffer into your offer negotiation. Premium processing reduces the adjudication window to roughly two weeks and is worth requesting for time-sensitive starts.
Document remote work arrangements explicitly in your petition
Risk adjustment coding is commonly performed remotely, but USCIS requires Labor Condition Applications to list all worksite locations. If you'll work from home, your employer must file an LCA covering your home address state to keep your petition in compliance.
Frequently Asked Questions
Is risk adjustment coding considered a specialty occupation for H-1B purposes?
It can qualify, but USCIS evaluates these petitions closely. The strongest cases pair a bachelor's degree in health information management, healthcare administration, or a clinical field with a CRC or CCS credential and a job description emphasizing complex ICD-10-CM hierarchical condition category analysis. Generic coding roles with broad degree requirements have faced RFEs, so specificity in the job description matters considerably.
Which employers are most likely to sponsor risk adjustment coders?
Medicare Advantage health plans, Medicaid managed care organizations, and large risk-bearing provider groups file the most LCAs for these roles. Companies running retrospective and prospective chart review programs at scale, including those serving CMS-contracted plans, tend to have active immigration programs. Browse open sponsorship roles on Migrate Mate to see which employers are currently hiring internationally.
Does a CRC certification substitute for a bachelor's degree in an H-1B petition?
No. USCIS requires a U.S. bachelor's degree or its equivalent in a specific specialty for H-1B visa classification. The CRC credential strengthens the specialty occupation argument but does not replace the degree requirement. If your degree is from outside the U.S., a credential evaluation from a NACES-member organization confirming equivalency to a U.S. bachelor's is required.
Can risk adjustment coders work remotely on an H-1B visa?
Yes, but the H-1B petition must reflect every location where work is performed. Your employer needs to file a Labor Condition Application listing your home address worksite, and you must have a copy of the LCA available at that location. Moving to a new state without updating the LCA and potentially amending the H-1B petition creates compliance risk for both you and your employer.
How long does green card sponsorship typically take for risk adjustment coding roles?
Most risk adjustment coders qualify under EB-3, which requires PERM labor certification before the I-140 immigrant visa petition. PERM itself takes roughly 18 to 24 months under current DOL processing times. For applicants born in India or China, priority date backlogs can extend total wait times considerably beyond that. EB-2 NIW is generally not applicable unless the role involves significant research or policy contributions.
What is the prevailing wage requirement for sponsored Risk Adjustment Coding jobs?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.