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Director Medicare Risk Adjustment Jobs (NOW HIRING)

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...

Cano Health

Risk Adjustment Coder III

Miami, FL · On-site

$18 - $24/hr

Provide guidance and support to junior coders as directed by leadership. * Participate in team ... Expertise of Medicare Risk Adjustment methodology. * Additional AAPC specialty certifications (CPMA ...

New

Centene

Risk Adjustment Auditor Educator

$56K - $101K/yr

... Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met ... Medicare risk adjustment (HCC Coding) Required Other experience in teaching, training or an ...

Cano Health

Risk Adjustment Coder III

Miami, FL · On-site

$18 - $24/hr

Provide guidance and support to junior coders as directed by leadership. * Participate in team ... Expertise of Medicare Risk Adjustment methodology. * Additional AAPC specialty certifications (CPMA ...

New

Centene Corp.

$56K - $101K/yr

... Director for the state assigned to ensure compliance of CMS risk adjustments guidelines are met ... Medicare risk adjustment (HCC Coding) required. * Other experience in teaching, training or an ...

Insight Global

Remote HCC Coder

Des Moines, IA · Remote

$19 - $22/hr

Day-to-Day Responsibilities Insight Global is seeking experienced HCC Risk Adjustment Medical Coders for a high-volume seasonal project supporting Medicare risk adjustment initiatives. Responsible ...

Insight Global

Remote HCC Medical Coder

Houston, TX · Remote

$19 - $22/hr

Day-to-Day Responsibilities Insight Global is seeking experienced HCC Risk Adjustment Medical Coders for a high-volume seasonal project supporting Medicare risk adjustment initiatives. Responsible ...

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Director Medicare Risk Adjustment information

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$102K

$135.9K

$143.5K

How much do director medicare risk adjustment jobs pay per year?

As of Sep 14, 2026, the average yearly pay for director medicare risk adjustment in the United States is $135,863.00, according to ZipRecruiter salary data. Most workers in this role earn between $137,500.00 and $141,000.00 per year, depending on experience, location, and employer.

What does a director Medicare Risk Adjustment do?

A Director of Medicare Risk Adjustment oversees the strategy, operations, and compliance of risk adjustment programs for Medicare Advantage plans. They ensure accurate data collection, coding, and submissions to optimize reimbursement while maintaining regulatory compliance. This role involves collaborating with cross-functional teams, managing analytics, and implementing initiatives to improve documentation and risk score accuracy. Additionally, they monitor policy changes and adjust processes to align with evolving CMS regulations.

What are the key skills and qualifications needed to thrive as a director Medicare Risk Adjustment?

To thrive as a Director Medicare Risk Adjustment, you need a strong background in healthcare administration, Medicare regulations, data analytics, and risk adjustment methodologies, often supported by a bachelor's or master's degree in a related field. Familiarity with risk adjustment software, claims processing systems, and proficiency in data analysis tools like SQL or SAS is essential, and certifications such as CRC (Certified Risk Adjustment Coder) can be advantageous. Outstanding leadership, cross-functional collaboration, and strong communication skills help drive teams toward accurate documentation and coding compliance. These competencies are crucial for optimizing revenue, ensuring regulatory adherence, and guiding strategic organizational initiatives in a complex healthcare environment.

What are some common challenges faced by a director Medicare Risk Adjustment, and how do they impact daily work?

Directors of Medicare Risk Adjustment frequently tackle challenges such as interpreting evolving CMS guidelines, ensuring complete and accurate documentation, and aligning interdepartmental teams around risk adjustment best practices. Keeping up with regulatory changes, managing large data sets, and training staff on coding compliance are all critical aspects of the job. These challenges require strong analytical skills, attention to detail, and the ability to communicate complex information to various stakeholders. Addressing these issues effectively is key to maintaining compliance, optimizing revenue accuracy, and helping your organization deliver quality care to Medicare populations.

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Director Medicare Risk Adjustment jobs near you
Infographic showing various Director Medicare Risk Adjustment job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 89% Full Time, 8% Part Time, and 2% Contract. Highlights an 82% Physical, 4% Hybrid, and 14% Remote job distribution, with an average salary of $135,863 per year, or $65.3 per hour.

HEALTH CODER - HCC & RISK ADJUSTMENT

Burlingame, CA • Remote

NORTH EAST MEDICAL SERVICES
Health Care and Social Assistance • 51 - 200 employees
Learn more about NORTH EAST MEDICAL SERVICESexternal

$42.79 - $48.75/hr

Full-time

Re-posted 15 hours ago

Job description

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization’s quality outcomes and financial performance.

ESSENTIAL JOB FUNCTIONS:

  • HCC Coding and Risk Adjustment (RA) Program Support
    • Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
    • Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
    • Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
  • Provider Training and Clinical Documentation Improvement (CDI)
  • Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
  • Provide one-on-one and group training to providers and clinical staff to improve documentation quality and accuracy.
  • Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.
  • Data Analysis and Reporting
    • Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
    • Generate reports and dashboards to track coding performance and documentation accuracy.
    • Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.
  • Compliance and Continuous Improvement
    • Stay up to date with changes in coding, risk adjustment, and Medicare regulations.
    • Assist in the development and implementation of internal coding policies and procedures.
    • Participate in quality improvement initiatives related to coding and documentation.
    • Performs other job duties as required by manager/supervisor
  • Education & Certification:
    • BS/BA Degree in Health Science or General Education is required. 
    • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification is required.
    • Additional CDI or auditing certifications (CCDS, CDEO, CPMA) are preferred.
  • Experience:
    • Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
    • Experience in provider education, clinical documentation improvement (CDI), and chart audits.
    • Previous experience working in an IPA, managed care organization, or similar setting is strongly preferred.
  • Skills & Competencies:
    • Excellent communication, presentation, and interpersonal skills.
    • Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
    • Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
    • Proficiency in electronic health records (EHR) and coding software.
    • Strong analytical and problem-solving skills.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluency in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This a full-time position. 

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