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Director Medicare Risk Adjustment Jobs (NOW HIRING)

Centrum Health

Risk Adjustment Analyst

Doral, FL

ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...

Genuine Health Group

MRA Coder

Miami, FL · On-site

$18 - $24/hr

... Medicare Risk Adjustment Director * Performs other duties as required. Requirements: * CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification * Minimum 3 years of Medicare Risk Adjustment coding

HealthEdge

Director, Risk Adjustment Products

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. The Director will work closely with ...

Centrum Health

Risk Adjustment Analyst

Doral, FL · On-site

ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...

HealthEdge

Director, Risk Adjustment Products

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. The Director will work closely with ...

MetroPlusHealth

Risk Adjustment Specialist

Manhattan, NY · Hybrid

$72K - $82K/yr

Position Overview Risk Adjustment is a growing and critical field within Health Insurance Finance ... Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines ...

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All JobsMedicare Risk Adjustment JobsDirector Medicare Risk Adjustment Jobs

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 Aug 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 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.

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.

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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 August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, and 3% Contract. Highlights an 88% Physical, 5% Hybrid, and 7% Remote job distribution, with an average salary of $135,863 per year, or $65.3 per hour.

Risk Adjustment Analyst

Centrum Health

Doral, FL

Full-time

Re-posted 15 days ago

Job description

SCOPE OF ROLE 

The Risk Adjustment and Analytics Team is working to push boundaries to redefine Risk Adjustment and Quality Analytics in a Value-Based Care Setting. The Risk Adjustment Analyst will be the lead in the design, implementation, and maintenance of all Risk Adjustment and Quality Data and Dashboards for our entire NeueHealth Portfolio: ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as Analytics, Risk Adjustment and Quality, Medical Economics, & Clinical Operations.

This is an onsite position in Doral, FL.

ROLE RESPONSIBILITIES

  • Proactively collaborate and interact with business stakeholders across the organization to understand analytics needs, develop plans to address those needs, and deliver analytics to meet those needs.
  • Using SQL code, mine data on medical spend, clinical data and population health data and derive meaningful insights to improve operations such as trends, correlations and patterns.
  • Own the data. You are responsible for accurate presentation of your data elements, so ensuring data integrity is paramount.
  • Thoroughly analyze data, quickly identify relevant information, and transform it into a meaningful output.  Conduct thoughtful presentations, online or in person, to stakeholders with actionable findings for improvement.
  • Provide concise data reports and clear data visualizations for executive level reporting through Power BI, Excel and other tools used by the organization.
  • Create data processes that are consistent, repeatable, and scalable.
  • Conduct Quarterly Reconciliations to identify dropped HCCs and prepare supplemental data submission files according to payor partner specifications.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • Bachelor's degree is required.
  • Comprehensive understanding of risk adjustment and quality programs across all government-regulated lines of business, including Marketplace, Medicaid, and Medicare programs.
  • Five (5) or more years of hands-on SQL code development is required, including expertise with programming languages like Scala or Python.
  • Three (3) or more years of experience in healthcare field dealing with claims/utilization as it pertains to Risk Adjustment and Quality.
  • Three (3) or more years of analytics experience (Required)
  • Two (2) or more years of Power BI experience (Required)
  • Experience with Databricks (Preferred)
  • Familiarity with CMS-HCC and HHS-HCC risk Adjustment Models
  • Familiarity with HEDIS and MSSP Quality Reporting

PROFESSIONAL COMPETENCIES

  • Expertise in analytics, statistics, data visualization, or programming
  • Dedicates exacting attention to detail and data quality
  • Eager learner, collaborative partner, easy communicator, and careful analyst
  • Passion for empirical research and answering hard questions with data

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