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Freelance Risk Adjustment Specialist Jobs (NOW HIRING)

MetroPlusHealth

Risk Adjustment Specialist

Manhattan, NY · Hybrid

$72K - $82K/yr

As a Risk Adjustment Specialist, you will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate ...

MetroPlusHealth

Risk Adjustment Specialist

Manhattan, NY · On-site

$72K - $82K/yr

As a Risk Adjustment Specialist, you will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate ...

The Alliance

Risk Adjustment Director

California, MO · On-site

$200 - $250/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... services, and specialist services * Develop, plan, organize, and direct finance programs and ... Medicare risk adjustment processes, a minimum of two years of experience related to Medicare ...

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Freelance Risk Adjustment Specialist information

What is a freelance risk adjustment specialist?

Freelance Risk Adjustment Specialists are professionals who work independently to review and analyze medical records for risk adjustment purposes. They ensure that diagnoses and medical codes are accurately captured and reported, which helps healthcare organizations receive appropriate reimbursement from insurance providers. These specialists often collaborate remotely with healthcare providers or organizations, using their expertise in coding standards such as ICD-10 and HCC. Their work is critical in identifying and documenting all patient conditions to reflect the complexity of patient populations.

What skills and qualifications are needed to be a freelance risk adjustment specialist?

To thrive as a Freelance Risk Adjustment Specialist, you need a strong understanding of medical coding (especially ICD-10), healthcare data analysis, and a background in health information management or a related field. Familiarity with risk adjustment software, electronic medical record (EMR) systems, and certifications such as CRC (Certified Risk Adjustment Coder) are typically required. Attention to detail, self-motivation, and effective communication skills help you excel in remote and client-facing environments. These qualifications are essential for ensuring accurate risk scores, compliance with regulations, and high-quality client deliverables in a dynamic healthcare landscape.

What challenges do freelance risk adjustment specialists face, and how can they be managed?

Freelance Risk Adjustment Specialists often encounter challenges such as navigating varying documentation standards across clients, staying updated on changing regulatory requirements, and managing fluctuating workloads. To manage these effectively, it's important to establish clear communication with each client regarding expectations, maintain up-to-date knowledge of coding guidelines (such as HCC or ICD-10), and utilize reliable project management tools to track assignments and deadlines. Building a strong network of professional contacts can also help with knowledge sharing and staying informed about industry trends.

What is the difference between Freelance Risk Adjustment Specialist vs Freelance Medical Coder?

AspectFreelance Risk Adjustment SpecialistFreelance Medical Coder
CredentialsCertifications like RAC, CRC, or RHIT often preferredCertifications such as CPC, CCS, or CCS-P typically required
Work EnvironmentRemote, insurance companies, healthcare organizationsRemote, hospitals, clinics, billing companies
Industry UsageUsed mainly in health insurance and risk adjustment programsUsed in medical billing, coding, and documentation

While both roles involve healthcare data, Freelance Risk Adjustment Specialists focus on analyzing and optimizing risk scores for insurance purposes, requiring specific risk adjustment certifications. Freelance Medical Coders primarily translate medical records into codes for billing, often holding coding certifications. Both roles are remote and essential in healthcare finance, but they serve different functions within the industry.

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The most popular types of Risk Adjustment Specialist jobs are:

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States with the most job openings for Freelance Risk Adjustment Specialist jobs include:

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The top searched job categories for Freelance Risk Adjustment Specialist jobs are:

Freelance Risk Adjustment Specialist jobs near you
Infographic showing various Freelance Risk Adjustment Specialist job openings in the United States as of August 2026, with employment types broken down into 94% Full Time, 3% Part Time, and 3% Contract. Highlights an 80% In-person, 3% Hybrid, and 17% Remote job distribution.

Risk Adjustment Specialist

MetroPlusHealth

Manhattan, NY • Hybrid

$72K - $82K/yr

Full-time

Posted 13 days ago

MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

271st of 310 rated insurance

Job description

Position Overview

Risk Adjustment is a growing and critical field within Health Insurance Finance. This is your opportunity

to support this function at MetroPlusHealth, New York City’s not-for-profit health insurance company. As a Risk Adjustment Specialist, you will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate information to federal and state agencies. You will work independently to monitor and support internal partners and external vendors in data collection and submission. You’ll apply your problem-solving skills to resolve issues you identify. You will also calculate errors and acceptance rates to track progress over time.

This opportunity is ideal for an individual interested in working at the intersection of Health Insurance Analytics and Operations, who excels at creative problem solving, is detail-oriented, and who is committed to our mission of providing access to health insurance to all New Yorkers.

Scope of Role and Responsabilities 

  • Ongoing monitoring of data submitted by vendors to ensure project goals are being met,
  • submitted data is complete and accurate, and errors are identified quickly.
  • Proactively work with external and internal partners to resolve issues – this includes identifying the root cause, devising plans to remediate, and ensuring on-time completion from all stakeholders.
  • Support end-to-end submission processes and encounter data across all lines of business, including Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines, resubmissions, and validating accepted and rejected encounter metrics to ensure data is accurately reflected in downstream reporting.
  • Perform financial impact analysis of Risk Adjustment activities, including implications of data errors, missed submissions, and remediation efforts.
  • Access and analyze data within the enterprise data warehouse to evaluate member, provider, claims, and enrollment data in support of Risk Adjustment and encounter data initiatives.
  • Utilize dashboards to identify trends and potential opportunities in data collection and reportng. 

Required Education, Training & Professional Experience

  • Bachelor’s degree required, with a demonstrated interest in Finance, Social Services or Health Care.
  • Minimum of 3-4 years’ experience required working for a Health Plan, or in a Finance, Project Management or Actuarial capacity in another industry.
  • Ability to work independently to investigate, pinpoint, and resolve problems.
  • Strong analytical and financial skills. Experience using SQL, R, SAS or another programming language is a plus.
  • Proactive communication style and ability to work with a variety of stakeholders to achieve project goals.

Professional Competencies 

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication

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