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Medicare Risk Adjustment Audit Jobs (NOW HIRING)

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with ... assurance audits, and collaborating with multiple departments across the organization. JOB ...

Harris Health System

Risk Adjustment Coder II

Houston, TX · On-site

$27.69 - $34.61/hr

... Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D ... assurance audits, and collaborating with multiple departments across the organization. JOB ...

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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 Jul 23, 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 July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 14% Part Time, and 8% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $89,650 per year, or $43.1 per hour.
Auditor, Risk Adjustment (Remote)

Auditor, Risk Adjustment (Remote)

Molina Healthcare

Long Beach, CA • On-site, Remote

$49K - $107K/yr

Full-time

Posted 7 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 195 frontline employees who took The Breakroom Quiz

147th of 281 rated insurance

Job description


JOB DESCRIPTION Job Summary
Provides audit support for Molina enterprise risk adjustment activities. Responsible for developing, recommending and implementing controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk, and estimates the potential financial consequences of an occurring loss. Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss.
Essential Job Duties
• Facilitates daily operations of all aspects of risk adjustment data validation and audit-related activities, including but not limited to: progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines.
• Represents as a risk adjustment audit liaison with functional departments, health plans, and external vendors.
• Evaluates results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans (CAPs) as necessary.
• Oversees Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data transmissions, and assists in identification of issues that impact data integrity and accuracy.
• Develops and implements processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data.
• Identifies opportunities for data mining to ensure data gaps are minimized.
• Applies best practices to ensure accuracy of risk adjustment payment in all markets.
• Supports all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are met.
• Performs monthly audits on internal Molina coding specialist performance..
• Facilitates audits on external Molina vendor performance.
Required Qualifications
• At least 5 years of coding, medical record chart review, and risk adjustment data validation experience, or equivalent combination of relevant education and experience.
• Certified Risk Adjustment Coder (CRC), Certified Coding Specialist (CCS), Certified Coding Specialist -Physician-based (CCS-P), or Certified Professional Coder (CPC).
• Excellent attention to detail, documentation and organizational skills.
• Critical-thinking, problem-solving and analytical skills.
• Ability to work independently in a fast-paced, deadline-driven environment.
Ability to work cross-collaboratively in a highly matrixed environment, including ability to communicate audit findings with internal teams.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs.
• Microsoft Excel experience at intermediate or better.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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