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Full Time Director Medicare Risk Adjustment Jobs

CINQCARE

Sr. Director, Risk Adjustment (0778)

Washington, DC · Remote

$146K - $183K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... Medicare Advantage, Medicaid Managed Care, and ACO REACH programs. The Sr. Director will lead a ... Develop and own the enterprise risk adjustment analytics strategy, roadmap, and governance ...

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 ...

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

MJHS

Director, Provider Education & Risk Adjustment

Manhattan, NY · On-site

$175K - $200K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Regular Full-Time Office: Hybrid Salary: $175,000.00 - $200,000.00 per year The challenges of ... Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding ...

Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82K - $108K/yr

... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

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All JobsMedicare Risk Adjustment JobsFull Time Director Medicare Risk Adjustment Jobs

Full Time Director Medicare Risk Adjustment information

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$102K

$135.9K

$143.5K

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

As of Aug 16, 2026, the average yearly pay for full time 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.
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What states have the most Full Time Director Medicare Risk Adjustment jobs?

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Full Time Director Medicare Risk Adjustment jobs near you
Infographic showing various Full Time Director Medicare Risk Adjustment job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 72% In-person, 7% Hybrid, and 21% Remote job distribution, with an average salary of $135,863 per year, or $65.3 per hour.

Senior Manager, Corporate Compliance - Risk Adjustment

CVS Health

Woonsocket, RI

$75K - $165K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 25 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,338 frontline employees who took The Breakroom Quiz

89th of 112 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.

The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.

Key Responsibilities

  • Lead the Medicare Advantage Risk Adjustment compliance program.

  • Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.

  • Assess operational processes for compliance risks related to risk adjustment activities.

  • Develop and implement corrective action plans for identified compliance issues.

  • Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.


Required Qualifications

  • Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance

  • Minimum 5 years in a leadership role

  • One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)

  • Willingness to travel up to 10% (including by plane)


Preferred Qualifications

  • Health Information Management (RHIA/RHIT)

  • Nursing - Strong understanding of clinical documentation and medical record review

  • Certified Risk Adjustment Coder (CRC) with compliance experience

  • Provider coding audit/compliance leadership experience

  • Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits


Education

Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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