ZipRecruiter

Log In

1

Data Analyst Medicare Risk Adjustment Jobs (NOW HIRING)

LSMA Management Inc

Medicare Provider Advocate

Fresno, CA · On-site

$36.05 - $38.46/hr

... Risk Adjustment principles, coding guidelines, and regulatory requirements Understanding of Medicare data collection, encounter data, and reporting processes Strong analytical and problem-solving ...

LSMA Management Inc

Medicare Provider Advocate

Fresno, CA · On-site

$36.05 - $38.46/hr

... Risk Adjustment principles, coding guidelines, and regulatory requirements · Understanding of Medicare data collection, encounter data, and reporting processes · Strong analytical and problem ...

next page

Showing results 1-20

All JobsData Analyst Medicare Risk Adjustment Jobs

Data Analyst Medicare Risk Adjustment information

See salary details

$34K

$82.6K

$136K

How much do data analyst medicare risk adjustment jobs pay per year?

As of Jun 22, 2026, the average yearly pay for data analyst medicare risk adjustment in the United States is $82,640.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,500.00 and $97,000.00 per year, depending on experience, location, and employer.

How does a Data Analyst in Medicare Risk Adjustment typically collaborate with clinical and actuarial teams?

Data Analysts in Medicare Risk Adjustment often work closely with clinical and actuarial teams to ensure data accuracy and support risk score calculations. They may participate in cross-functional meetings to interpret healthcare data, validate coding accuracy, and discuss trends affecting patient risk profiles. Effective communication is key, as analysts must translate complex data findings into actionable insights for both technical and non-technical stakeholders. This collaboration ensures compliance with CMS guidelines and drives improvements in healthcare quality and reimbursement accuracy.

What does a Data Analyst in Medicare Risk Adjustment do?

A Data Analyst in Medicare Risk Adjustment is responsible for analyzing healthcare claims and patient data to ensure accurate risk adjustment coding and reporting for Medicare Advantage plans. Their work helps health plans receive appropriate payments based on the health status and risk profiles of their members. They use statistical tools and data modeling to identify trends, detect errors, and support compliance with regulatory requirements. Additionally, they often collaborate with clinical and operational teams to improve data quality and support business decisions.

What are the key skills and qualifications needed to thrive as a Data Analyst in Medicare Risk Adjustment, and why are they important?

To thrive as a Data Analyst in Medicare Risk Adjustment, you need strong analytical skills, proficiency in statistics, and a solid understanding of healthcare data, often supported by a degree in a quantitative field. Familiarity with data analysis tools such as SQL, SAS, Python, and experience with risk adjustment models and CMS regulations are typically required. Attention to detail, problem-solving abilities, and effective communication are vital soft skills for interpreting complex data and collaborating with clinical and business teams. These skills ensure accurate analysis, regulatory compliance, and actionable insights that improve healthcare outcomes and drive organizational success.

What is the difference between Data Analyst Medicare Risk Adjustment vs Data Analyst Healthcare Claims Processing?

AspectData Analyst Medicare Risk AdjustmentData Analyst Healthcare Claims Processing
CertificationsRelevant certifications like CPC, RHIT, or RHIA often preferredSimilar certifications, often including CPC or coding certifications
Work EnvironmentHealthcare insurance companies, Medicare Advantage plansHospitals, insurance companies, or healthcare providers
Industry UsagePrimarily in Medicare and government-funded programsAcross various healthcare settings handling claims data

While both roles involve analyzing healthcare data, Data Analyst Medicare Risk Adjustment focuses on optimizing Medicare risk scores and ensuring compliance with Medicare regulations. In contrast, Data Analyst Healthcare Claims Processing centers on managing and analyzing claims data to facilitate accurate billing and reimbursement across healthcare providers.

Risk Adjustment Analyst

PCC MEDICAL HOLDINGS LLC

North Palm Beach, FL • On-site

$65K - $75K/yr

Full-time

Posted 26 days ago

Job description

Risk Adjustment Specialist – Primary Care
Location: Remote
Employment Type: Full-Time
Pay : $65K - $75K
About Us
Here at Physician Care Centers, we are a patient-centered primary care organization committed to delivering high-quality, value-based care. Our team partners with providers to improve patient outcomes while ensuring accurate clinical documentation and coding practices.
Position Overview
We are seeking a detail-oriented Risk Adjustment Specialist to support our value-based care initiatives. In this role, you will work closely with providers and clinical teams to ensure accurate documentation and coding of patient conditions, helping reflect the true complexity of our patient population.
What You’ll Do
  • Perform pre-visit and post-visit chart reviews to identify risk adjustment opportunities
  • Ensure accurate ICD-10-CM and HCC coding based on clinical documentation
  • Partner with providers to clarify diagnoses and improve documentation quality
  • Educate providers and staff on risk adjustment and coding best practices
  • Track and monitor Risk Adjustment Factor (RAF) scores and performance metrics
  • Support internal and external audits and ensure compliance with Centers for Medicare & Medicaid Services (CMS) guidelines
  • Stay current on coding updates and value-based care requirements
What We’re Looking For
  • 2+ years of experience in risk adjustment, medical coding, or primary care
  • Strong knowledge of ICD-10-CM and HCC coding
  • Certification such as CRC or CPC preferred
  • Experience working with electronic health records (EHRs)
  • Excellent attention to detail and analytical skills
  • Strong communication skills and ability to collaborate with providers
Why Join Us?
  • Competitive salary and benefits package
  • Opportunity to work in a growing value-based care environment
  • Collaborative and supportive team culture
  • Professional development and certification support