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Freelance Risk Adjustment Specialist Jobs (NOW HIRING)

Molina Healthcare

Auditor, Risk Adjustment (Remote)

$49K - $107K/yr

... specialist performance.. • Facilitates audits on external Molina vendor performance. Required Qualifications • At least 5 years of coding, medical record chart review, and risk adjustment data ...

Insight Global

REMOTE Risk Adjustment Coder

Tampa, FL · Remote

$23 - $25/hr

Insight Global is hiring experienced and CPC certified Risk Adjustment Coding Specialist (HCC) to support Medicare Advantage risk adjustment initiatives. This role will focus primarily on concurrent ...

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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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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 Coding Specialist II

Astrana Health, Inc.

Monterey Park, CA • Hybrid

$75K - $85K/yr

Full-time

Posted 13 days ago

Job description

Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to the Supervisor - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects.
Our Values: 
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company 
  • Review medical record information on both a retrospective and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) 
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines 
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation 
  • Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned 
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing 
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements. 
  • Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success. 
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives. 
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. 
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager. 
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I 

Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required
  • 3+ years experience in risk adjustment coding required. Billing experience is a plus. 
  • Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time 
  • PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint
  • Excellent presentation, verbal and written communication skills, and ability to collaborate
  • Must possess the ability to educate and train provider office staff members 
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems. 
You’re great for the role if: 
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage 
  • Ability to work independently and collaborate in a team setting 
  • Strong organizational and time-management skills 
  • Ability to work in a home office for continuous periods of time for business continuity 
  • Ability to travel across the Provider Clinic service region for meetings and/or training as needed 
  • Able to work independently and within time constraints
  • Able to efficiently prioritize multiple high-priority tasks

Environmental Job Requirements and Working Conditions
  • This position blends on-site fieldwork (approximately 75% travel) with hybrid support to help practices. The Company reserves the right to modify the work arrangement, including transitioning to a hybrid or onsite model, based on business needs. Disclaimer: This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, or qualifications required. Responsibilities may change based on business needs and organizational priorities.
  • The national target pay range for this role is $75,000 - $85,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. 
 
Additional Information: 
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.