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Medicare Risk Adjustment Audit Jobs in Michigan (NOW HIRING)

Kanak Elite Services Inc

Sr. Business Analyst

Grand Rapids, MI · On-site

$88K - $114K/yr

We're looking for a Risk Adjustment Business Analyst with strong expertise in CMS regulations, Medicare Advantage, and compliance-driven program execution. The ideal candidate will combine regulatory ...

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Medicare Risk Adjustment Audit information

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.
What are popular job titles related to Medicare Risk Adjustment Audit jobs in Michigan? For Medicare Risk Adjustment Audit jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment Audit jobs in Michigan look for? The top searched job categories for Medicare Risk Adjustment Audit jobs in Michigan are:
What cities in Michigan are hiring for Medicare Risk Adjustment Audit jobs? Cities in Michigan with the most Medicare Risk Adjustment Audit job openings:
Medicare Risk Adjustment Audit jobs near you
Infographic showing various Medicare Risk Adjustment Audit job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, and 3% Contract. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution.

Risk Adjustment Coding Coordinator (onsite), full time, days

Holland Hospital

Holland, MI • On-site

$23.30 - $34.95/hr

Full-time

Re-posted 29 days ago

Holland Hospital rating

6.5

Company rating: 6.5 out of 10

Based on 33 frontline employees who took The Breakroom Quiz

717th of 1,055 rated hospitals

Job description

CURRENT HOLLAND HOSPITAL EMPLOYEES- Please apply through Find Jobs from your Workday employee account.

The Coordinator will support Hierarchical Condition Category (HCC) coding risk adjustment initiatives across value-based care contracts by preparing medical records, performing documentation review, ensuring accurate capture of diagnosis codes, and educating providers. This role partners closely with providers, clinical staff, coding teams and operational leadership to optimize HCC capture and improve documentation integrity.
Qualifications:
Professional coding certification; Certified Risk Adjustment Coder (CRC) strongly preferred or required within 12 months of hire
Experience with risk adjustment programs preferred.
Prior provider education or clinical collaboration experience preferred.
Excellent communication skills for provider education and stakeholder collaboration

Employment Type: Full Time

Shift: Mon-Thrs- 8am-4:30pm Fri- 8a-12p

Weekly Scheduled Hours: 36

Wage Range: $23.30 - $34.95 per hour

Weekend Requirements: NA
Requirements:

- High school diploma/GED or higher education

-Certified Professional Coder (C-CPC)

Clinical Documentation Review & Risk Adjustment Coding

  • Prepare and manage risk adjustment visit workflows, including maintaining patient lists, diagnosis summaries, and assisting with scheduling coordination.
  • Conduct comprehensive previsit chart reviews to identify and validate ICD10-CM diagnoses that accurately represent each patient's health status.
  • Perform postvisit documentation analysis to ensure proper ICD10-CM code assignment, diagnosis specificity, and compliance with MEAT (Monitor, Evaluate, Assess, Treat) criteria.
  • Maintain uptodate knowledge of CMS risk adjustment regulations, HCC models, and clinical documentation and coding standards.
  • Support organizational value-based care goals by collaborating with Manager, Quality and clinical teams to ensure compliant risk adjustment documentation.

Provider Engagement, Education & Clinical Support

  • Serve as a clinical documentation and coding subject matter expert, supporting providers in achieving compliant and accurate risk adjustment practices.
  • Deliver ongoing education and feedback to providers and coders regarding documentation standards, diagnosis specificity, and optimal risk adjustment coding principles.
  • Identify documentation gaps or inconsistencies and communicate findings through structured, actionable feedback, including formalized documentation queries as needed.
  • Promote a culture of documentation excellence that supports quality outcomes, operational performance, and compliant value-based care delivery.

Audit, Reporting & Performance Monitoring

  • Conduct routine and targeted chart audits to assess documentation quality, coding accuracy, and HCC recapture performance.
  • Track, analyze, and report key risk adjustment performance indicators, including recapture rates, suspect condition closure, documentation accuracy, and provider-level trends.
  • Collaborate with operational leaders to integrate risk adjustment best practices into existing clinical workflows and identify opportunities for process improvement.
  • Participate in quality assurance initiatives, report findings to leadership, and support the development of corrective action plans or workflow enhancements.

Holland Hospital is an Equal Opportunity Employer, please see our EEO policy

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