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Director Health Plan Risk Adjustment Jobs (NOW HIRING)

ISHE

Experience the fulfillment of advancing the health of your community with the excitement of ... Growing together. The Executive Director of Risk Adjustment is responsible for leading the ...

Cano Health

Risk Adjustment Coder III

Miami, FL

$18 - $24/hr

We are committed to building the best primary care environment for patients and are seeking health ... Provide guidance and support to junior coders as directed by leadership. * Participate in team ...

New

Liberty Health

RISK ADJUSTMENT CODER

Wilmington, NC · Remote

$16 - $21.50/hr

There's no place like Liberty Healthcare Management Come explore career opportunities with Liberty ... RISK ADJUSTMENT CODER (MUST RESIDE IN NC) Job Summary: * Perform code abstraction of medical ...

Liberty Health

RISK ADJUSTMENT CODER

Wilmington, NC · On-site

$16 - $21.50/hr

There's no place like Liberty Healthcare Management Come explore career opportunities with Liberty ... RISK ADJUSTMENT CODER (MUST RESIDE IN NC) Job Summary: * Perform code abstraction of medical ...

Centrum Health

Risk Adjustment Data Analyst

Doral, FL · On-site

SCOPE OF ROLE The Risk Adjustment and Analytics Team is working to push boundaries to redefine Risk ... Using SQL code, mine data on medical spend, clinical data and population health data and derive ...

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Director Health Plan Risk Adjustment information

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$54K

$143.2K

$260K

How much do director health plan risk adjustment jobs pay per year?

As of Sep 13, 2026, the average yearly pay for director health plan risk adjustment in the United States is $143,185.00, according to ZipRecruiter salary data. Most workers in this role earn between $105,500.00 and $167,500.00 per year, depending on experience, location, and employer.

What is the difference between Director Health Plan Risk Adjustment vs Health Plan Risk Adjustment Analyst?

AspectDirector Health Plan Risk AdjustmentHealth Plan Risk Adjustment Analyst
CredentialsTypically requires advanced degrees (e.g., Master’s), certifications like CPC, CRC, or RHIA, and extensive experienceOften requires a bachelor’s degree, certifications like CPC or CRC, and entry to mid-level experience
Work EnvironmentLeadership roles overseeing teams, strategy, and compliance within health plansData analysis, coding, and reporting tasks within health plan operations
Employer & Industry UsageUsed in health insurance companies, managed care organizations, and healthcare consulting firmsCommonly employed in health plans, healthcare providers, and analytics firms

The main difference is that the Director Health Plan Risk Adjustment holds a leadership role with strategic responsibilities, while the Health Plan Risk Adjustment Analyst focuses on data analysis and coding tasks. The director oversees teams and ensures compliance, whereas analysts support operational functions within the risk adjustment process.

What are popular job titles related to Director Health Plan Risk Adjustment jobs?

For Director Health Plan Risk Adjustment jobs, the most frequently searched job titles are:

Infographic showing various Director Health Plan Risk Adjustment job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 76% Full Time, 17% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $143,185 per year, or $68.8 per hour.

Risk Adjustment - Risk Adjustment Auditor 135-2032

Tulsa, OK • On-site

CommunityCare, Inc.
See more jobs at CommunityCare, Inc.external

Other

Posted 3 days ago

New

Job description

Tulsa, OK, USA

Job Description

Posted Tuesday, September 8, 2026 at 6:00 AM

JOB SUMMARY:
The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards. This role plays a critical part in supporting accurate risk score calculation, regulatory compliance, and overall program integrity.

KEY RESPONSIBILITIES
  • Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.
  • Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.
  • Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.
  • Provide detailed audit findings and recommendations to coding teams, providers, and leadership.
  • Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards.
  • Track and report audit results, trends, and performance metrics.
  • Collaborate with coding staff, providers, and operations teams to improve documentation quality and coding accuracy.
  • Assist with education and training initiatives related to risk adjustment and documentation best practices.
  • Maintain confidentiality and ensure compliance with HIPAA regulations.
  • Meet daily and weekly productivity goals and quality standards set by the supervisor.
  • Perform other job-related duties as required or assigned.
QUALIFICATIONS
  • Knowledge of CMS-HCC and HHS-HCC risk adjustment model.
  • Knowledge of ICD-10-CM coding guidelines.
  • Knowledge of RADV requirements.
  • Proficiency in EMR systems and Microsoft Office (Excel preferred).
  • High attention to detail.
  • Strong analytical and critical thinking skills.
  • Clear written and verbal communication.
  • Ability to work independently and meet deadlines.
  • Strong organizational skills.
  • Integrity and commitment to compliance.
  • Successful completion of Health Care Sanctions background check.
EDUCATION/EXPERIENCE
  • A minimum of two years of risk adjustment coding or auditing experience.
  • Experience reviewing medical records across multiple specialties.
  • Certified Professional Coder (CPC), CRC, CCS, or equivalent coding certification.
  • Bachelor’s degree in Health Information Management or related field preferred.
  • Previous auditing experience in Medicare Advantage and ACA preferred.
  • Experience with internal audit programs or payer audits preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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