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Hcc Risk Adjustment Medical Coder Jobs (NOW HIRING)

NorthShore

Medical Coder II

Warrenville, IL · On-site

$24.86 - $37.29/hr

Medical Coder II This position has a deep understanding of disease process, A&P and pharmacology ... HCC risk adjustment) and surgical services under general supervision. * Communicates daily ...

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition ... Complying with medical coding guidelines and policies * Reviewing patients' charts and documents ...

Endeavor Health

Medical Coder II

Warrenville, IL

$24.86 - $37.29/hr

Medical Coder II This position has a deep understanding of disease process, A&P and pharmacology ... HCC risk adjustment) and surgical services under general supervision. * Communicates daily ...

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition ... Complying with medical coding guidelines and policies * Reviewing patients' charts and documents ...

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

With deep expertise in the CMS-HCC Risk Adjustment Payment Model (V28), Hierarchical Condition ... Complying with medical coding guidelines and policies * Reviewing patients' charts and documents ...

Cano Health

Risk Adjustment Coder

Jupiter, FL

The Risk Adjustment Coder is required to follow procedures and documentation policies regarding ... Review medical record information to identify all appropriate coding based on CMS HCC categories

Cano Health

Risk Adjustment Coder

Jupiter, FL · On-site

The Risk Adjustment Coder is required to follow procedures and documentation policies regarding ... Review medical record information to identify all appropriate coding based on CMS HCC categories

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Hcc Risk Adjustment Medical Coder information

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How much do hcc risk adjustment medical coder jobs pay per hour?

As of Jun 26, 2026, the average hourly pay for hcc risk adjustment medical coder in the United States is $22.42, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $24.04 per hour, depending on experience, location, and employer.

What are HCC Risk Adjustment Medical Coders?

HCC Risk Adjustment Medical Coders are professionals who review and analyze medical records to assign appropriate ICD-10 codes for diagnoses and procedures. Their primary goal is to ensure accurate documentation for Hierarchical Condition Category (HCC) risk adjustment, which affects healthcare reimbursement and quality reporting for Medicare Advantage and other risk-based programs. These coders play a critical role in helping healthcare organizations receive appropriate payments and in supporting high-quality patient care by ensuring that all relevant health conditions are properly documented.

What is the difference between Hcc Risk Adjustment Medical Coder vs Medical Coder?

AspectHcc Risk Adjustment Medical CoderMedical Coder
CertificationsCertified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC)Certified Professional Coder (CPC), Certified Coding Associate (CCA)
Work EnvironmentHealthcare facilities, insurance companies, risk adjustment teamsHospitals, clinics, physician offices
Industry UsageHealth plans, Medicare Advantage, MedicaidHospitals, outpatient clinics, physician practices

The main difference between an Hcc Risk Adjustment Medical Coder and a Medical Coder lies in their focus. Hcc Risk Adjustment Medical Coders specialize in risk adjustment coding for health plans, requiring knowledge of HCC models and risk scores. Medical Coders generally focus on clinical coding for billing and documentation across various healthcare settings. While both roles require coding certifications, Hcc Risk Adjustment Medical Coders have additional expertise in risk models and insurance industry standards.

What are some common challenges faced by HCC Risk Adjustment Medical Coders, and how can they be addressed?

HCC Risk Adjustment Medical Coders often encounter challenges such as interpreting complex patient records, keeping up with frequent updates to coding guidelines, and ensuring accurate capture of diagnoses for risk adjustment. To address these, coders benefit from strong attention to detail, regular training on ICD-10 and CMS risk adjustment updates, and effective communication with providers to clarify clinical documentation. Many coders also collaborate with auditing teams to resolve discrepancies and ensure compliance with regulatory standards, which helps maintain coding accuracy and data integrity.

What are the key skills and qualifications needed to thrive as an HCC Risk Adjustment Medical Coder, and why are they important?

To thrive as an HCC Risk Adjustment Medical Coder, you need a thorough understanding of ICD-10-CM coding, risk adjustment models, and healthcare regulations, typically supported by a coding certification such as CPC, CRC, or CCS. Proficiency with electronic health record (EHR) systems, coding software, and data analytics tools is essential for accurate documentation and reporting. Attention to detail, analytical thinking, and strong communication skills help coders interpret clinical documentation and collaborate with providers. These skills ensure accurate risk adjustment coding, which directly impacts healthcare reimbursement and compliance.
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Hcc Risk Adjustment Medical Coder jobs near you
Infographic showing various Hcc Risk Adjustment Medical Coder job openings in the United States as of June 2026, with employment types broken down into 1% Locum Tenens, 96% Full Time, 1% Part Time, 1% Temporary, and 1% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $46,638 per year, or $22.4 per hour.
Risk Adjustment - Risk Adjustment Coding Analyst 135-2014

Risk Adjustment - Risk Adjustment Coding Analyst 135-2014

CommunityCare

Tulsa, OK • On-site

Full-time

Posted 4 days ago

Job description

JOB SUMMARY:
This role will report directly to the Supervisor of Clinical and Risk Coding and is responsible for clinical and risk adjustment audits for both Medicare Advantage and ACA Programs. Ensuring accurate and appropriate documentation. Audits include Vendors, provider groups, and individual providers. Will also provide medical coding support and HEDIS assistance to the Reporting department. This role will support all seasonal and ad-hoc project assignments for both clinical and risk adjustment.
KEY RESPONSIBILITIES:
  • Ensure ICD codes submitted to CMS for the Risk Adjustment Payment System are accurate, appropriate, and supported by written clinical documentation in accordance with all federal and state regulations.
  • Adhere to all official coding rules and CMS guidelines for risk adjustment programs. Ensure accuracy, completeness, specificity, and appropriateness of diagnosis information.
  • Surveillance of CPT, CMS, and other regulations and their impact related to coding and other business functions.
  • Risk Adjustment Validation Audits (RADV), conduct chart review of inpatient and outpatient medical records for Hierarchal Condition Category (HCC) coding.
  • Review results of risk adjustment audits to identify coding patterns and provide the information back to the supervisor.
  • Provide accurate data results/reports of provider claims and clinical notes audited.
  • Recommend general and specific education topics based on CMS/HHS guidelines to the supervisor in written form (e.g., email, word, etc.)
  • Meet with the supervisor to discuss potential education with the provider groups and other stakeholders to provide coding education and support.
  • Assist with the annual HEDIS medical record review process.
  • Receives assignment to evaluate Medicare Wellness Visit documentation for accuracy and completeness in addressing gaps in care and expiring HCCs. Present findings to the supervisor on a regularly scheduled basis.
  • Perform evaluation /prioritize results of new Medicare Advantage and Marketplace member self-reported health risk assessments for risk adjustment conditions that should be addressed. Create analyses, summary reporting, and coordinate with providers
  • Provide support to health data analysts on medical coding questions and follow up with the supervisor on any issues that need to be resolved.
  • Support medical record requests and retrieval projects.
  • Perform other job-related duties as assigned.

QUALIFICATIONS:
  • Extensive knowledge of ICD, HCPCS, and CPT codes.
  • Knowledge of risk adjustment payment models and risk adjustment coding preferred
  • Familiarity with State and federal regulations governing healthcare preferred
  • Health plan/medical practice experience
  • Medicare Advantage and ACA knowledge preferred
  • Able to work independently and meet stringent deadlines.
  • Strong attention to detail.
  • Possess strong oral and written communication skills
  • Successful completion of Health Care Sanctions background check.
  • Proficient in Microsoft Office applications.

Metric Requirements
Performance will be evaluated using the following indicators:
  • Quality
    • Audit Accuracy Rate: ≥ 95-98% coding accuracy
    • Documentation Defensibility Score: 100% alignment with MEAT/ICD-10-CM standards
    • Compliance Audit Pass Rate: Minimum threshold set by organization (e.g., ≥ 95%)
  • Productivity
    • Audit Volume: 25-30 charts/cases per day or week (based on specialty and chart type)
    • Turnaround Time: Meets established SLA for completion (e.g., 48-72 hours per batch)
  • Improvement Impact
    • Reduction in Repeat Findings: Continuous improvement trend quarter-to-quarter
    • Timely Remediation Rate: ≥ 90% of corrections and follow-ups completed within the required timeframe
    • Provider/Coder Feedback Engagement: Participation in education aligned with audit trends
  • Financial Integrity
    • RAF Score Accuracy: Maintains accurate correlation between HCC capture and reimbursement
    • Lost Revenue Opportunity Reduction: Identifies and prevents under-coding where compliant and appropriate

EDUCATION/EXPERIENCE:
  • Coding certification nationally recognized by the AAPC or AHIMA is required.
  • Minimum of two years of coding experience utilizing ICD-CM coding required.
  • Experience or familiarity with state and federal regulations governing healthcare.
  • Two years' experience with claims processing systems, coding programs, and electronic medical records preferred.
  • Previous HMO or health insurance experience preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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