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Medicare Risk Adjustment Jobs (NOW HIRING)

Village Care

Risk Adjustment Coding Manager

Manhattan, NY · On-site

$102K - $115K/yr

Medicare Risk Adjustment Coding Manager Location: Remote (Must Reside in NY/NJ/CT) Work Schedule: Monday - Friday, 9:00am - 5:00pm Compensation: $102,549.17 - $115.367.82 Annual Salary Join ...

Village Care

Risk Adjustment Coding Manager

Manhattan, NY · On-site

$102K - $115K/yr

Medicare Risk Adjustment Coding Manager Location: Remote (Must Reside in NY/NJ/CT) Work Schedule: Monday - Friday, 9:00am - 5:00pm Compensation: $102,549.17 - $115.367.82 Annual Salary Join ...

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How much do medicare risk adjustment jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for medicare risk adjustment in the United States is $22.42, according to ZipRecruiter salary data. Most workers in this role earn between $16.11 and $27.16 per hour, depending on experience, location, and employer.

What Are Jobs in Medicare Risk Adjustment?

Jobs in Medicare risk adjustment include work in data analytics, consulting, insurance, and closely related industries. Your duties and responsibilities differ depending on the type of work. For example, as a Medicare risk-adjustment consultant, you provide advice and recommendations to healthcare organizations or an insurance provider on how to mitigate risk across a customer pool. Data analytics and statistics specialists gather and analyze insurance and Medicare data and documentation from hospitals, healthcare providers, and other medical care facilities that accept Medicare. This includes reviewing different types of diagnosis and comparing patient chart information. Some health care providers have in-house risk adjustment workers, while others contract with outside consulting and analytics firms.

What is the difference between Medicare Risk Adjustment vs Medicare Coding Specialist?

AspectMedicare Risk AdjustmentMedicare Coding Specialist
Primary FocusAssessing patient health risk scores for reimbursementAccurately coding medical diagnoses and procedures
Required CredentialsCertifications in risk adjustment or coding, often CPC or RHITCertifications like CPC, CCS, or RHIT
Work EnvironmentHealth plans, risk adjustment companies, healthcare providersHospitals, clinics, billing departments
Industry UsageUsed for Medicare Advantage plan reimbursementsUsed for medical billing and claims processing

While both roles involve healthcare coding and require similar certifications, Medicare Risk Adjustment focuses on evaluating patient health data to determine reimbursement levels, whereas Medicare Coding Specialists concentrate on accurately coding diagnoses and procedures for billing purposes.

What is Medicare Risk Adjustment?

Medicare Risk Adjustment is a process used by the Centers for Medicare & Medicaid Services (CMS) to adjust payments to Medicare Advantage plans based on the health status and demographic characteristics of their enrolled beneficiaries. The goal is to ensure that plans receive appropriate compensation for taking care of members with varying levels of health risk. This system uses diagnosis codes and other data to predict future healthcare costs, encouraging plans to provide comprehensive care and accurately document patient conditions.

What are some common challenges faced by professionals working in Medicare Risk Adjustment roles?

Professionals in Medicare Risk Adjustment often encounter challenges such as staying current with frequently changing CMS regulations, ensuring the accurate capture and documentation of patient diagnoses, and collaborating effectively with providers to optimize risk scores. The role requires meticulous attention to detail when reviewing medical records and coding, as well as strong communication skills to educate and support healthcare teams. Additionally, there can be pressure to meet strict deadlines for data submission and to ensure compliance with audit standards.

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

To excel in Medicare Risk Adjustment, you need a solid understanding of medical coding (especially ICD-10), healthcare regulations, and risk adjustment methodologies, often supported by credentials like CRC or CPC certifications. Familiarity with data analytics platforms, EHR systems, and specialized risk adjustment software is typically required. Strong attention to detail, analytical thinking, and effective communication are crucial soft skills for interpreting complex clinical data and collaborating across teams. These competencies ensure accurate risk scores, compliance with CMS requirements, and optimal financial outcomes for healthcare organizations.
More about Medicare Risk Adjustment jobs
What cities are hiring for Medicare Risk Adjustment jobs? Cities with the most Medicare Risk Adjustment job openings:
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Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in the United States as of June 2026, with employment types broken down into 1% Locum Tenens, 6% As Needed, 45% Full Time, 44% Part Time, and 4% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $46,633 per year, or $22.4 per hour.
Medicare Risk Adjustment Specialist - Medical Assistant

Medicare Risk Adjustment Specialist - Medical Assistant

Complete Health

Jacksonville, FL • On-site

$16.50 - $20.75/hr

Full-time

Posted 16 days ago

Complete Health rating

6.8

Company rating: 6.8 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

Job description

SUMMARY OF JOB DUTIES:
Searching for a strong Medical Assistant or Certified Nursing Assistant for a rapidly growing company who would like to come off the floor and become a Medicare Risk Adjustment Specialist.
ESSENTIAL JOB FUNCTIONS:
  • Reviews medical record and claims information to identify all appropriate coding based on Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC & HHS-HCC) models
  • Abstract all risk adjusted diagnosis codes from acceptable provider documentation and in accordance with industry standards for coding and reporting.
  • Adherence to current industry standard, as defined in the ICD-10 guidelines for coding and reporting.
  • Conduct Provider queries for any documentation for risk conditions within client electronic medical record and/or other query system
  • Develop and share guidelines/best practices with internal risk adjustment coders to improve coding documentation techniques.
  • Help with special projects within our Risk Adjustment Department

KNOWLEDGE/SKILLS/ABILITIES:
  • Critical Thinking
  • Excellent time management skills and ability to multi-task and prioritize work
  • Strong organizational and planning skills
  • Flexibility
  • Team Player
  • Autonomy

MINIMUM REQUIREMENTS
  • High School Diploma or Equivalent (Required)
  • Medical Assistant or Certified Nursing Assistant
  • 2 -- 3 years Back Office, Primary Care preferred

WORKING ENVIRONMENT
The position requires climbing, stooping, kneeling, crouching, reaching, standing, lifting, grasping, feeling, talking, hearing, repetitive motions, and finger use. Pushing and pulling are occasionally required. Use of a computer, keyboard, and telephone along with various office machines is an essential part of the job.
DISCLAIMER
The above statements are intended to describe the general nature and level of work being performed by the Medicare Risk Adjustment Coder. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The Medicare Risk Adjustment Coder may be required to perform duties outside of their normal responsibilities from time to time as needed or as directed by supervision.

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