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Medicare Risk Adjustment Audit Jobs (NOW HIRING)

Village Care

Risk Adjustment Coding Manager

Manhattan, NY · On-site

$102K - $115K/yr

A CPC, CPMA, CRC, CCS-P, CCS, RHIA, or RHIT certification is essential, along with at least five years of experience in Medicare Risk Adjustment coding and familiarity with RADV audits. Proficiency ...

Village Care

Risk Adjustment Coding Manager

Manhattan, NY · On-site

$102K - $115K/yr

A CPC, CPMA, CRC, CCS-P, CCS, RHIA, or RHIT certification is essential, along with at least five years of experience in Medicare Risk Adjustment coding and familiarity with RADV audits. Proficiency ...

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Medicare Risk Adjustment Audit information

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$31K

$89.7K

$126.5K

How much do medicare risk adjustment audit jobs pay per year?

As of Jun 9, 2026, the average yearly pay for medicare risk adjustment audit in the United States is $89,650.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,500.00 and $116,500.00 per year, depending on experience, location, and employer.

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

To thrive as a Medicare Risk Adjustment Auditor, you need expertise in medical coding, healthcare compliance, and an understanding of CMS risk adjustment guidelines, often supported by a coding certification such as CPC or CRC. Familiarity with auditing software, electronic health records (EHRs), and data analytics tools is typically required. Attention to detail, analytical thinking, and strong communication are essential soft skills for reviewing documentation and conveying findings. These skills are crucial for ensuring accurate risk adjustment coding, regulatory compliance, and optimized reimbursement for healthcare organizations.

What are some common challenges faced by professionals in Medicare Risk Adjustment Audit roles, and how can they be addressed?

Professionals in Medicare Risk Adjustment Audit roles often encounter challenges such as interpreting complex medical documentation, staying updated on evolving CMS guidelines, and ensuring data accuracy for compliant risk scoring. Effective collaboration with coders, providers, and compliance teams is essential to resolve discrepancies and achieve audit objectives. Staying proactive in ongoing training and leveraging audit technologies can help address these challenges and contribute to high-quality, compliant results.

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

AspectMedicare Risk Adjustment AuditMedicare Coding Specialist
Primary FocusReviewing and verifying accuracy of risk adjustment dataAssigning correct medical codes for billing and documentation
CertificationsRisk adjustment or auditing certifications often preferredMedical coding certifications like CPC or CCS
Work EnvironmentHealthcare organizations, insurance companies, auditing firmsHospitals, clinics, billing companies
Industry UsageUsed in Medicare Advantage plan compliance and reimbursementUsed in medical billing and claims processing

While both roles involve healthcare data, Medicare Risk Adjustment Auditors focus on verifying the accuracy of risk scores for Medicare payments, whereas Medicare Coding Specialists assign medical codes for billing purposes. Understanding these differences helps in choosing the right career path or job focus within the healthcare industry.

What is a Medicare Risk Adjustment Audit?

A Medicare Risk Adjustment Audit is a review process conducted to ensure that healthcare providers are accurately reporting patient diagnoses to Medicare Advantage plans. This audit verifies that submitted diagnoses are supported by proper medical documentation, which affects how much Medicare pays to health plans. The goal is to prevent overpayments or underpayments and to ensure compliance with federal regulations. These audits are typically performed by the Centers for Medicare & Medicaid Services (CMS) or their contractors.
More about Medicare Risk Adjustment Audit jobs
What cities are hiring for Medicare Risk Adjustment Audit jobs? Cities with the most Medicare Risk Adjustment Audit job openings:
What states have the most Medicare Risk Adjustment Audit jobs? States with the most job openings for Medicare Risk Adjustment Audit jobs include:
What job categories do people searching Medicare Risk Adjustment Audit jobs look for? The top searched job categories for Medicare Risk Adjustment Audit jobs are:
Medicare Risk Adjustment Audit jobs near you
Infographic showing various Medicare Risk Adjustment Audit job openings in the United States as of May 2026, with employment types broken down into 96% Full Time, and 4% Contract. Highlights an 78% In-person, 2% Hybrid, and 20% Remote job distribution, with an average salary of $89,650 per year, or $43.1 per hour.
Risk Adjustment Coding Manager

Risk Adjustment Coding Manager

Village Care

Manhattan, NY • On-site

$102K - $115K/yr

Full-time

Posted 20 days ago

Job description

Position: 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 VillageCare as a Full-Time Medicare Risk Adjustment Coding Manager and enjoy the thrill of playing a vital role in healthcare's future while working from the comfort of your home. This position offers unparalleled flexibility, allowing you to balance personal and professional commitments seamlessly. Envision being part of a team that prioritizes excellence and customer-centric solutions in the ever-evolving health care landscape, all while residing in the vibrant city of New York, NY. As a key player in our organization, you will lead initiatives that directly impact patient care and financial outcomes. The compensation for this role ranges from $102,549.17 to $115,367.82, reflecting the importance we place on your expertise and leadership.
If you are a smart problem solver with a passion for integrity and high-performance culture, consider applying to be a part of our forward-thinking team.
VillageCare: Our Mission
VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.
Are you excited about this Medicare Risk Adjustment Coding Manager job?
The Risk Adjustment Coding Manager at VillageCare plays a crucial role in enhancing healthcare quality and operational efficiency. This position is responsible for coordinating Risk Adjustment and Quality coding operations, emphasizing documentation integrity across both areas. The manager will oversee retrospective and prospective chart review programs while supervising the Risk Adjustment coding staff and managing day-to-day vendor operations. Acting as the operational bridge between Risk Adjustment and the HEDIS/Quality abstraction team, the manager ensures that all medical record interactions are utilized effectively for Hierarchical Condition Category (HCC) accuracy and closing quality gaps.
By eliminating redundant provider outreach and maximizing the clinical value of each chart interaction, this role aims to achieve year-over-year improvements in Risk Adjustment accuracy, Risk Adjustment Factor (RAF) performance, and STARs quality measure outcomes, directly impacting patient care and organizational success.
Requirements for this Medicare Risk Adjustment Coding Manager job
To excel as the Risk Adjustment Coding Manager at VillageCare, candidates must possess a robust set of skills and qualifications. A CPC, CPMA, CRC, CCS-P, CCS, RHIA, or RHIT certification is essential, along with at least five years of experience in Medicare Risk Adjustment coding and familiarity with RADV audits. Proficiency in HEDIS measure specifications and quality gap closure operations is highly preferred. Candidates should have a strong command of ICD-10 and CPT codes, as well as experience using electronic medical record systems.
Excellent communication skills are vital for effectively collaborating within the department and with cross-functional teams. Additionally, a Bachelor's degree in Business Administration, Finance, or a relevant field, or equivalent work experience, is required, ensuring that the candidate is well-equipped to navigate the complexities of healthcare coding and operational management.
Knowledge and skills required for the position are:
  • CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification.
  • Experience with HEDIS measure specifications and quality gap closure operations preferred
  • 5+ years of Medicare Risk Adjustment coding including work on RADV audits
  • Previous experience using electronic medical record systems.
  • Strong knowledge of ICD-10 and CPT codes
  • Excellent communication skills to facilitate working with teammates within the department and cross-functional teams.
  • Bachelor's degree in Business Administration, Finance or relevant field OR equivalent work experience required
Are you ready for an exciting opportunity?
If you have these qualities and meet the basic job requirements, we'd love to have you on our team. Apply now using our online application!

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