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Hcc Risk Adjustment Jobs in California (NOW HIRING)

Astiva Health

Healthcare Data Analyst

Orange, CA · On-site

$85K - $115K/yr

Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements. * Experience analyzing pharmacy adherence metrics ...

Urrly

Telehealth Nurse Practitioners

Los Angeles, CA · On-site +1

$600 - $720/day

Document risk adjustment (HCC coding) during patient visits * Close HEDIS care gaps during visits * Review medical history, medications, and preventive needs * Document visits using ICD-10 and CPT II ...

Astiva Health

Healthcare Data Analyst

Orange, CA

$85K - $115K/yr

Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements. * Experience analyzing pharmacy adherence metrics ...

High Desert Medical Group

HCC Coordinator

Lancaster, CA · On-site

$23.45 - $31.30/hr

This department strives to be the leading innovator in risk adjustment, quality reporting, and financial sustainability through teamwork, integrity, and education. The HCC Coordinator ensures all ...

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All JobsHcc Risk Adjustment JobsHcc Risk Adjustment Jobs in California

Hcc Risk Adjustment information

See California salary details

$10.9K

$140.5K

$187.5K

How much do hcc risk adjustment jobs pay per year?

As of Aug 15, 2026, the average yearly pay for hcc risk adjustment in California is $140,459.00, according to ZipRecruiter salary data. Most workers in this role earn between $130,800.00 and $130,800.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the HCC Risk Adjustment position, and why are they important?

To excel in HCC Risk Adjustment, you need a solid understanding of medical coding, clinical documentation, healthcare regulations, and disease management, usually coupled with experience in coding certifications like CPC or CRC. Familiarity with Hierarchical Condition Category (HCC) models, data analytics tools, and electronic health record (EHR) systems is essential. Attention to detail, analytical thinking, and strong communication skills make a candidate stand out in this role. These skills ensure accurate risk adjustment coding and documentation, which are vital for appropriate reimbursement and compliance in the healthcare industry.

What are the main responsibilities of someone working in HCC Risk Adjustment?

Professionals in HCC Risk Adjustment are typically responsible for reviewing medical records, ensuring accurate coding of diagnoses aligned with CMS guidelines, and collaborating with providers to improve documentation. The role often involves analyzing patient data to identify risk gaps and providing education to clinical staff on best practices for compliant coding. Team members regularly coordinate with data analysts, providers, and compliance teams to support accurate reporting and optimal reimbursement. Overall, attention to detail and clear communication are key to meeting the organization's compliance and financial objectives.

What is an HCC Risk Adjustment?

An HCC Risk Adjustment job involves reviewing medical records to ensure accurate coding of diagnoses under the Hierarchical Condition Category (HCC) model. This role helps determine risk scores for patients, which impact healthcare provider reimbursements in Medicare Advantage and other risk-adjusted programs. Professionals in this field, such as medical coders or auditors, analyze documentation to assign appropriate ICD-10-CM codes that reflect a patient's health status. Strong attention to detail and knowledge of coding guidelines are essential for success in this role.

What are the most commonly searched types of Hcc Risk Adjustment jobs in California?

The most popular types of Hcc Risk Adjustment jobs in California are:

What are popular job titles related to Hcc Risk Adjustment jobs in California?

For Hcc Risk Adjustment jobs in California, the most frequently searched job titles are:

What job categories do people searching Hcc Risk Adjustment jobs in California look for?

The top searched job categories for Hcc Risk Adjustment jobs in California are:

What cities in California are hiring for Hcc Risk Adjustment jobs?

Cities in California with the most Hcc Risk Adjustment job openings:

Hcc Risk Adjustment jobs near you
Infographic showing various Hcc Risk Adjustment job openings in California as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 9% Part Time, 2% Temporary, and 2% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $140,459 per year, or $67.5 per hour.

Healthcare Data Analyst

Astiva Health

Orange, CA • On-site

$85K - $115K/yr

Full-time

Re-posted 28 days ago

Job description

About Us:
Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
SUMMARY:
The Healthcare Data Analyst is responsible for analyzing healthcare data to support clinical, operational, and financial decision-making within Medicare Advantage programs. This role focuses on key areas including risk adjustment, quality measures (HEDIS and Star Ratings), pharmacy adherence, and claims analysis.
The analyst collaborates with clinical, quality, pharmacy, and provider teams to identify trends, monitor program performance, and support CMS regulatory reporting. The role also includes developing automated data workflows and reporting solutions that deliver timely, actionable insights across the organization.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
Data Analysis & Reporting
  • Analyze medical and pharmacy claims, membership, supplement, lab, risk adjustment, and encounter data to support Medicare Advantage quality, risk, and operational programs.
  • Develop and maintain dashboards and reports for HEDIS, Star Ratings, medication adherence, RAF/HCC performance, and EDPS encounter data.
  • Identify trends, care gaps, and performance opportunities to support quality improvement, pharmacy initiatives, and risk adjustment efforts.
  • Provide analytics and reporting to MSOs/IPAs and internal teams, including quality, pharmacy, and risk adjustment.
  • Support regulatory and CMS-related analyses, including encounter data monitoring, claims acceptance, and HCC performance.
  • Deliver consolidated reporting and insights to leadership for strategic decision-making.
  • Examine payments, cost of care, and utilization data to produce metrics for bid submission and JOMs or to address concerns from business partners.
  • Support ad hoc reporting needs across the organization.

Data Quality & Validation
  • Validate and reconcile claims, pharmacy, provider, membership, supplement, and lab data to ensure accuracy and completeness.
  • Investigate and resolve data discrepancies, anomalies, and reporting issues across Medicare Advantage data sources.

Technical & Database Work
  • Write and optimize SQL queries and stored procedures for data extraction, transformation, and analysis.
  • Develop automated ETL workflows and data pipelines to support ongoing reporting needs.
  • Work with large datasets in SQL Server and healthcare analytics platforms.
  • Build dashboards and data visualizations using Power BI or SSRS.
  • Utilize tools such as SQL Server, SSIS, Power BI, SSRS, Python, and Excel.

Collaboration
  • Partner with clinical, pharmacy, quality, enrollment, credentialing, and finance teams to interpret results and support program initiatives.
  • Assist with regulatory and compliance-related reporting requirements.
  • Present findings and insights to both technical and non-technical stakeholders

Requirements
Required Qualifications
  • Bachelor's degree in Data Analytics, Health Informatics, Statistics, Computer Science, or related field.
  • 2-5+ years of healthcare data analytics experience.
  • Knowledge of Medicare Advantage programs, HEDIS, and/or CMS Star Ratings.
  • Advanced SQL skills for querying and analyzing large datasets.
  • Experience with BI tools such as Power BI, SSRS, or similar tools.
  • Strong analytical, problem-solving, and communication skills.

Preferred Qualifications
  • Experience working in Medicare Advantage organizations, MSOs, or managed care settings.
  • Knowledge of HCC risk adjustment, RAF methodologies, capitation payment model, DOFR, claim processing, bid design, and CMS regulatory requirements.
  • Experience analyzing pharmacy adherence metrics (e.g., PDC).
  • Familiarity with EDPS encounter data, claims submissions, and acceptance processes.
  • Experience with ETL tools (e.g., SSIS) or programming languages such as Python or .NET.

Salary Description
$85,000 - $115,000/annually

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