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Humana Risk Adjustment Coding Jobs (NOW HIRING)

Medasource

Risk Adjustment Coder

Manhattan, NY · On-site

$20.75 - $27.50/hr

This role is responsible for reviewing and validating diagnosis coding, ensuring documentation accuracy, and supporting audit readiness initiatives related to CMS HCC risk adjustment programs.

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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 Specialist I

Risk Adjustment Coding Specialist I

Millennium Physician Group

Remote

Full-time

Posted 7 days ago

Millennium Physician Group rating

6.2

Company rating: 6.2 out of 10

Based on 59 frontline employees who took The Breakroom Quiz

687th of 865 rated healthcare providers

Job description

Job Description Summary
Formed in 2008 and headquartered in Fort Myers, Florida, with offices in Florida, North Carolina, and Texas, Millennium Physicians Group (MPG) is the largest independent physician group in the state of Florida and one of the largest in the United States. At Millennium Physician Group, our employees are the foundation of our success. Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual and help you grow in your role.
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, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care.
This position is responsible for risk adjustment coding and quality assurance validation for the following programs, including but not limited to:
• Prospective medical record review
• Concurrent outpatient claim diagnosis coding
• Retrospective medical record and provider response reviews
How will you make an impact & Requirements
Level I
  • Perform prospective medical record reviews for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.
  • Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.
  • Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.
  • Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.
  • Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.
  • Stays current on applicable coding and documentation guideline changes and rules.
  • This role is expected to maintain a consistent accuracy rate of 95% or higher and able to meet productivity standards established by leadership.
  • Perform other job-related duties as assigned by leadership.

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