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Medicare Risk Adjustment Audit Jobs in Virginia (NOW HIRING)

DaMar Staffing

IPA Consultative Coder

Newport News, VA · On-site

$59 - $81/hr

Required Qualifications: * 3+ years of risk adjustment Medical Coding or risk adjustment Provider ... Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and ...

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Tria Federal

Senior Product Analyst

Arlington, VA · On-site

The candidate will serve as the Product Analyst/Scrum Master fora developmentteam responsible for executing risk adjustment model runsat the Centers for Medicare & Medicaid.The individual ...

Riverside

Compliance Analyst RMG

Newport, VA · Remote

$57K - $78K/yr

Overview Primary responsibility is to independently perform clinical chart reviews, risk adjustment audits, payor audits, coding analysis, charge/reimbursement analysis, medical records reviews, and ...

Albanymed

Senior Professional Coder

Broadway, VA · Remote

$64K - $97K/yr

Code chronic disease that meets HCC and Risk Adjustment criteria. Validate missed coding opportunities. * Conducts professional fee billing integrity reviews/audits for AMHS, including reviewing ...

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Medicare Risk Adjustment Audit information

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 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 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 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 are popular job titles related to Medicare Risk Adjustment Audit jobs in Virginia?

For Medicare Risk Adjustment Audit jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Medicare Risk Adjustment Audit jobs in Virginia look for?

The top searched job categories for Medicare Risk Adjustment Audit jobs in Virginia are:

Medicare Risk Adjustment Audit jobs near you
Infographic showing various Medicare Risk Adjustment Audit job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution.

Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*

Hueman Risk Adjustment Solutions

Chase City, VA

$105K - $135K/yr

Contractor

Re-posted 22 days ago

Job description

Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Chase City, VA.
This unique opportunity adapts to your lifestyle, giving you the freedom to achieve your professional goals on your terms, all while enjoying a schedule designed with your preferences in mind. Whether it be for supplemental income or the desire for community connection, this position invites you to become an integral part of the thriving HRA landscape, fostering connections that go beyond the clinic. 

Benefits include:   

  • Competitive compensation and travel reimbursement  
  • Flexible schedule 
  • Comprehensive home assessment training 
  • Dedicated patient scheduling assistance 
  • Liability insurance options 

Position Summary 

Qualified Nurse Practitioners and Physician Assistants interested in this position will have the opportunity to interact with members in a more intimate setting. Unlike a typical clinic visit, this role allows NPs and PAs to connect with patients on a more personal and effective level. Nurse Practitioners and Physician Assistants performing HRAs are not required to treat or prescribe in the home.  

Nurse Practitioner/Physician Assistant Responsibilities 

  • Travel to and from patients’ homes. 
  • Perform comprehensive, non-invasive physical assessments. 
  • Review medical history and ensure accurate and timely documentation.  
  • Conduct medical reconciliation to ensure patient safety and compliance. 
  • Provide basic patient education on wellness and preventative healthcare measures.  

Nurse Practitioner/Physician Assistant Qualifications and Experience Requirements:  

  • Master’s Degree OR commensurate experience and satisfactory completion of NP/PA license 
  • Active State NP/PA license 
  • Active National board certification 
  • Current BLS certification 
  • 12 months of experience as a paid advanced clinical provider is preferred but not required 

To learn more about this position, please use this link to schedule a call with a member of our recruitment team.  
About Hueman 

At Hueman, we're dedicated to guiding you toward fulfilling career opportunities.  

We believe that happiness should be a fundamental part of every role in risk assessment. Our opportunities provide flexibility, extra income, and integration into your local healthcare network. If this resonates with your idea of career satisfaction, allow us to assist you in discovering your next healthcare position! 

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