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Humana Risk Adjustment Coding Jobs (NOW HIRING)

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health's commitment to value-based care under Medicare ...

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health's commitment to value-based care under Medicare ...

Gather Health

Risk Adjustment Coding Specialist

Boston, MA · On-site

$65K - $85K/yr

The Risk Adjustment Coding Specialist will play a pivotal role in supporting accurate and complete diagnosis documentation as part of Gather Health's commitment to value-based care under Medicare ...

Strive Health

Risk Adjustment Coder

Denver, CO · Remote

$27.88 - $32.21/hr

What You'll Do The Coder, Risk Adjustment Coding is responsible for supporting the Strive ... They will review assigned provider's documentation and coding from end to end, including proper ...

Strive Health

Risk Adjustment Coder

Denver, CO · On-site

$19.25 - $25.75/hr

What You'll Do The Coder, Risk Adjustment Coding is responsible for supporting the Strive ... They will review assigned provider's documentation and coding from end to end, including proper ...

Boston Medical Center

Risk Adjustment Coder

$19.25 - $25.50/hr

Risk adjustment coding relies on ICD-10-CM coding to assign risk scores to patients. The incumbent reviews retrospective medical record documentation and ensures that the codes are appropriately ...

Millennium Physician Group

OR

Under the direction of Burden of Illness department leadership, the Risk Adjustment Coding Specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain ...

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Humana Risk Adjustment Coding information

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$12

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$27

How much do humana risk adjustment coding jobs pay per hour?

As of Jun 4, 2026, the average hourly pay for humana risk adjustment coding in the United States is $18.30, according to ZipRecruiter salary data. Most workers in this role earn between $15.62 and $18.27 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Humana Risk Adjustment Coder, and why are they important?

To excel as a Humana Risk Adjustment Coder, you need a thorough understanding of medical coding guidelines (ICD-10-CM), risk adjustment models, and a relevant certification such as CPC, CRC, or CCS. Familiarity with electronic health record (EHR) systems, coding software, and Humana-specific risk adjustment tools is typically required. Attention to detail, analytical thinking, and effective communication are critical soft skills for accurately interpreting medical documentation and collaborating with healthcare providers. These skills ensure accurate coding, compliance, and optimal reimbursement, directly impacting organizational performance and patient outcomes.

What are some common challenges faced by professionals in Humana Risk Adjustment Coding, and how can they be addressed?

Professionals in Humana Risk Adjustment Coding often encounter challenges such as staying updated with frequent changes in coding guidelines, managing large volumes of complex patient data, and ensuring accuracy to maximize appropriate reimbursements. These challenges can be addressed by regularly participating in training sessions, utilizing coding tools and resources, and collaborating closely with clinical teams to clarify documentation. Effective time management and attention to detail are also key to handling these responsibilities successfully in a fast-paced environment.

What is Humana Risk Adjustment Coding?

Humana Risk Adjustment Coding refers to the process of reviewing and assigning medical codes to patient diagnoses and procedures for members insured by Humana. This coding helps accurately reflect the health status of patients and ensures appropriate risk adjustment for insurance reimbursement. By capturing all relevant diagnoses, risk adjustment coding helps Humana predict healthcare costs and allocate resources more effectively. Accurate coding also ensures compliance with government regulations and supports quality patient care.

What is the difference between Humana Risk Adjustment Coding vs Medical Coding Specialist?

AspectHumana Risk Adjustment CodingMedical Coding Specialist
CredentialsCPH, CPC, or CCS certifications often preferredCPC, CCS, or equivalent certifications
Work EnvironmentHealthcare insurance companies, provider offices, or remoteHospitals, clinics, or physician offices
Industry UsagePrimarily in health insurance and risk adjustment programsBroadly in healthcare settings for billing and documentation

Humana Risk Adjustment Coding focuses on accurately coding patient data for risk adjustment in insurance plans, ensuring proper reimbursement and compliance. Medical Coding Specialists handle a wider range of medical procedures and diagnoses for billing purposes across various healthcare settings. While both roles require coding certifications, Humana Risk Adjustment Coders specialize in insurance-related coding, whereas Medical Coding Specialists work across diverse medical environments.

Infographic showing various Humana Risk Adjustment Coding job openings in the United States as of May 2026, with employment types broken down into 92% Full Time, and 8% Contract. Highlights an 54% In-person, and 46% Remote job distribution, with an average salary of $38,059 per year, or $18.3 per hour.
Risk Adjustment Coding Auditor

Risk Adjustment Coding Auditor

Blue Cross and Blue Shield of Minnesota

Eagan, MN • Remote

$31.48 - $39.35/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Blue Cross Blue Shield Of Minnesota rating

5.3

Company rating: 5.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

249th of 260 rated insurance

Job description

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

Blue Cross and Blue Shield of Minnesota is hiring a Risk Adjustment Coding Auditor. The Risk Adjustment Coding Auditor ensures the accuracy and completeness of coded clinical data to support compliant reporting and appropriate reimbursement across risk adjustment programs. The role strengthens organizational performance by identifying coding and documentation gaps, mitigating financial and regulatory risk, and improving data integrity. It provides subject matter expertise to support consistent application of coding standards and enables informed decision-making across the enterprise.

An ideal candidate has 5+ years of risk adjustment coding experience and an active CRC certification. This is a production-based role requiring comfort in a high-volume environment.

Your Responsibilities

  • Evaluates risk adjustment codes to ensure accuracy, consistency, and alignment with coding standards and best practices
  • Protects patient records and audit information by ensuring compliance with HIPAA, privacy, security, and regulatory requirements
  • Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting
  • Verifies and ensures the accuracy, completeness, specificity and appropriateness of providerreported diagnosis codes based on medical record documentation
  • Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories
  • Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements
  • Contributes to audit and production efforts to meet business demand and workload priorities
  • Provide written and verbal guidance on coding errors to others
  • Meets audit deliverables within established timelines and deadlines
  • Assists with special projects such as risk mitigation reviews
  • Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment

Required skills and experiences:

  • 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
  • 5+ years of HCC coding experience in utilizing inpatient and outpatient coding guidelines
  • 5+ years of experience auditing Risk Adjustment records
  • 1+ years working in a Production environment
  • CRC (Certified Risk Coder) in good standing, in addition to required coding certification or ability to obtain certification within the first 6 months of hire.
  • Intermediate level of knowledge in risk adjustment Medicare, ACA Commercial and Medicaid models
  • Demonstrated ability to apply critical thinking skills to coding policy interpretation and implementation.
  • Experience providing written and verbal guidance on coding errors and trends
  • Intermediate (or higher) MS Office (Word, Excel, Powerpoint & Outlook)
  • Excellent organizational ability to manage multiple projects and perform in a deadline driven environment
  • High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred skills and experiences

  • Bachelor's degree
  • HEDIS/STARS experience
  • Provider education experience
  • Prior RADV experience
  • CPMA or other coding credentials
Role DesignationTeleworker

Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.

Compensation and Benefits$31.48 - $39.35 - $47.22 Hourly

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

  • Medical, dental, and vision insurance

  • Life insurance

  • 401k

  • Paid Time Off (PTO)

  • Volunteer Paid Time Off (VPTO)

  • And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

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