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Certified Risk Adjustment Coder Jobs in Illinois

Bcbsa

Head of Medicare Performance Hub

Chicago, IL · On-site

CMS Star Ratings, Risk Adjustment/HCC coding accuracy, or Medical Cost Management (utilization ... certifications, relevant experience, skills, seniority, performance, shift, travel requirements ...

Capital One

Risk Manager

Riverwoods, IL · On-site

Certified Risk Manager (CRM) or PMP certification At this time, Capital One will not sponsor a new ... San Francisco, California Police Code Article 49, Sections 4901-4920; New York City's Fair Chance ...

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Certified Risk Adjustment Coder information

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$16

$28

$68

How much do certified risk adjustment coder jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for certified risk adjustment coder in Illinois is $28.38, according to ZipRecruiter salary data. Most workers in this role earn between $21.20 and $28.17 per hour, depending on experience, location, and employer.

What is a Certified Risk Adjustment Coder?

A Certified Risk Adjustment Coder is a professional who specializes in reviewing and coding medical records to ensure accurate documentation of diagnoses for risk adjustment purposes. These coders play a crucial role in healthcare reimbursement, especially for Medicare Advantage and other risk-adjusted health plans. They analyze patient records using ICD-10-CM codes to help healthcare organizations receive appropriate compensation based on the severity of patient conditions. Certified Risk Adjustment Coders typically hold certifications such as the CRC from the AAPC, demonstrating their expertise in this specialized field.

What are the key skills and qualifications needed to thrive as a Certified Risk Adjustment Coder, and why are they important?

To thrive as a Certified Risk Adjustment Coder, you need expertise in medical coding, a thorough understanding of ICD-10-CM guidelines, and certification such as CRC (Certified Risk Adjustment Coder). Familiarity with coding software, electronic health records (EHRs), and risk adjustment models like HCC is typically required. Attention to detail, analytical thinking, and strong communication skills help ensure accurate code assignment and effective collaboration with healthcare providers. These skills and qualifications are crucial for capturing precise patient data, which directly impacts healthcare reimbursement and compliance.

What are some common challenges Certified Risk Adjustment Coders face, and how can they overcome them?

Certified Risk Adjustment Coders often encounter challenges such as staying current with evolving coding guidelines and accurately interpreting complex medical records. To overcome these difficulties, coders should regularly participate in ongoing education, leverage resources from professional organizations, and collaborate closely with providers to clarify documentation. Maintaining a strong attention to detail and utilizing coding software tools can also help minimize errors and improve coding accuracy. Engaging in peer reviews within the team can further enhance consistency and knowledge sharing.

What is the difference between Certified Risk Adjustment Coder vs Certified Medical Coder?

AspectCertified Risk Adjustment CoderCertified Medical Coder
CertificationsRequires risk adjustment-specific credentials like RAC, CRC, or CPC-RRequires CPC or CCS certifications
Work EnvironmentPrimarily in health insurance, risk adjustment, and payer settingsHospitals, clinics, physician offices, and outpatient facilities
Industry UsageUsed mainly in health insurance and risk adjustment programsUsed across healthcare providers for medical coding and billing

The Certified Risk Adjustment Coder specializes in coding for risk adjustment programs within health insurance, focusing on accurate documentation for reimbursement. In contrast, the Certified Medical Coder works across various healthcare settings, primarily coding diagnoses and procedures for billing. While both roles require coding certifications, their focus areas and work environments differ significantly.

How do you become a certified risk adjustment coder?

To become a certified risk adjustment coder, you typically need to complete relevant training or coursework in medical coding and risk adjustment, gain experience in medical billing or coding, and pass a certification exam such as the Certified Risk Adjustment Coder (CRC) offered by the American Academy of Professional Coders (AAPC). Continuing education is often required to maintain certification and stay current with industry updates.

Is certified risk adjustment coding a good career?

Certified risk adjustment coding is a growing field within healthcare, focusing on accurately coding patient diagnoses for insurance reimbursement and risk assessment. It requires knowledge of medical terminology, coding systems like ICD-10, and often involves certification such as the RAC or CRC. The role offers stable employment opportunities, competitive salaries, and the potential for remote work, making it a viable career choice for those interested in healthcare administration and coding.

What are popular job titles related to Certified Risk Adjustment Coder jobs in Illinois?

For Certified Risk Adjustment Coder jobs in Illinois, the most frequently searched job titles are:

What job categories do people searching Certified Risk Adjustment Coder jobs in Illinois look for?

The top searched job categories for Certified Risk Adjustment Coder jobs in Illinois are:

What cities in Illinois are hiring for Certified Risk Adjustment Coder jobs?

Cities in Illinois with the most Certified Risk Adjustment Coder job openings:

Certified Risk Adjustment Coder jobs near you
Infographic showing various Certified Risk Adjustment Coder job openings in Illinois as of August 2026, with employment types broken down into 2% As Needed, 80% Full Time, 12% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $59,033 per year, or $28.4 per hour.

Senior Manager, Corporate Compliance - Risk Adjustment

CVS Health

Northbrook, IL

$75K - $165K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 10 hours ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,341 frontline employees who took The Breakroom Quiz

91st of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.

The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.

Key Responsibilities

  • Lead the Medicare Advantage Risk Adjustment compliance program.

  • Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.

  • Assess operational processes for compliance risks related to risk adjustment activities.

  • Develop and implement corrective action plans for identified compliance issues.

  • Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.


Required Qualifications

  • Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance

  • Minimum 5 years in a leadership role

  • One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)

  • Willingness to travel up to 10% (including by plane)


Preferred Qualifications

  • Health Information Management (RHIA/RHIT)

  • Nursing - Strong understanding of clinical documentation and medical record review

  • Certified Risk Adjustment Coder (CRC) with compliance experience

  • Provider coding audit/compliance leadership experience

  • Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits


Education

Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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