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Hcc Risk Adjustment Jobs (NOW HIRING)

CINQCARE

Sr. Director, Risk Adjustment (0778)

Washington, DC · Remote

$146K - $183K/yr

Deep expertise in CMS-HCC, HHS-HCC, and CDPS risk adjustment models. * Advanced proficiency in Python and/or R for statistical modeling, machine learning, and large-scale data analysis. * Strong ...

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Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site +1

$137K - $184K/yr

... HCC) methodology, Medicaid risk adjustment guidelines, and ACA Marketplace risk adjustment ... requirements as applicable. * Owns and governs the end-to-end data flow from coding vendor output ...

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Hcc Risk Adjustment information

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$11K

$142.3K

$190K

How much do hcc risk adjustment jobs pay per year?

As of Jul 2, 2026, the average yearly pay for hcc risk adjustment in the United States is $142,322.00, according to ZipRecruiter salary data. Most workers in this role earn between $132,500.00 and $132,500.00 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 job?

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.

More about Hcc Risk Adjustment jobs
What cities are hiring for Hcc Risk Adjustment jobs? Cities with the most Hcc Risk Adjustment job openings:
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Hcc Risk Adjustment jobs near you
Infographic showing various Hcc Risk Adjustment job openings in the United States as of June 2026, with employment types broken down into 98% Full Time, 1% Part Time, and 1% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $142,322 per year, or $68.4 per hour.
Quality Risk Adjustment Advisor IV (Health Plan experience required)

Quality Risk Adjustment Advisor IV (Health Plan experience required)

CareSource

Dayton, OH • On-site, Remote

$83K - $132K/yr

Full-time

Posted 7 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

180th of 277 rated insurance

Job description

Job Summary:
The Quality Risk Adjustment Advisor IV is responsible for leading key components of the Quality Risk Adjustment (QRA) programs, including prospective programs, chart retrieval and coding processes, while ensuring compliance with regulatory standards and optimizing quality outcomes. This role partners closely with internal stakeholders and external vendors to enhance operational effectiveness and leverage artificial intelligence (AI) technologies to improve data accuracy, efficiency, and overall program performance.
Essential Functions:
  • Serve as a subject matter expert in Risk Adjustment operations, supporting prospective programs, chart retrieval and coding processes.
  • Identify and recommend strategies to optimize risk adjustment processes and improve quality metrics across insourced and outsourced activities, including leveraging AI for process enhancement.
  • Partner with vendors to support execution of operational production plans and contractual requirements.
  • Monitor vendor performance and identify opportunities to improve efficiency, quality, and cost management.
  • Collaborate with QRA Compliance to support development and maintenance of quality assurance protocols.
  • Conduct audits and assessments to ensure accuracy, completeness, and efficiency.
  • Research and evaluate technological solutions, including AI/NLP tools.
  • Partner with Data Science, IT, and Sourcing teams to support deployment of AI solutions.
  • Collaborate with cross-functional teams to support operational goals.
  • Identify and implement process improvements.
  • Monitor and analyze key performance indicators (KPIs).
  • Gather and translate business requirements into actionable recommendations.
  • Assess build vs. buy AI solutions.
  • Support evaluation and monitoring of AI solution performance.
  • Provide guidance and informal coaching to stakeholders as needed.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in Health Administration, Healthcare Management, or a related field required
  • Master's degree is preferred
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Seven (7) years experience in risk adjustment, medical record review, coding, or quality management required
  • Two (2) years experience with AI solutions in a healthcare setting required
  • Leadership experience preferred
Competencies, Knowledge and Skills:
  • Knowledge of ICD-10 Coding
  • Knowledge of HCC Risk Adjustment models
  • Knowledge of CMS regulatory guidelines
  • Strong analytical and problem-solving skills
  • Ability to apply AI technologies in healthcare
  • Strong communication and collaboration skills
  • Ability to influence stakeholders without direct authority
Licensure and Certification:
  • None
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Travel is not typically required

Compensation Range:
$83,000.00 - $132,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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