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Medicare Risk Adjustment Audit Jobs in Wisconsin

Doist

Telehealth Nurse Practitioner

Madison, WI · On-site

$110.70 - $132.84/hr

Familiar with HEDIS and risk adjustment workflows * Medicare and Medicaid provider enrollment required * Comfortable delivering care through telehealth platforms * Ability to consistently work ...

New

CorroHealth Inc

WI · On-site

$70 - $90/hr

Risk adjustment models (e.g., Medicare Advantage HCCs); Outpatient E/M documentation requirements * Experience working in an ambulatory EHR (Epic, Cerner, or similar) Skills & Competencies * Strong ...

New

Palm Medical Centers

WI · On-site

$200 - $300/hr

Provide comprehensive primary care services to adult and senior population within the Medicare ... Strong understanding of HEDIS, STAR ratings, risk adjustment, and preventative care measures.

Humana Inc

Healthcare Market Finance Lead

Madison, WI · On-site

$104 - $143/hr

Analyze market financials, claims data, utilization trends, membership movement, risk adjustment ... Experience in the Medicare Advantage bid process * 3 or more years of experience in Service Fund ...

New

Let'sGetChecked

WI · On-site

$240 - $270/hr

... HIPAA, HITECH, Medicare PartD, Medicaid, state pharmacy regulations, and other healthcare ... Lead responses to regulatory audits, inspections, investigations, complaints, and inquiries from ...

ThedaCare

Coder (Clinic - III)

Neenah, WI · On-site

$19.25 - $25.75/hr

Audits medical record documentation and educates providers on documentation improvement ... risk adjustment diagnosis) for professional services including specialty medical services, in and ...

ThedaCare

Coder (Clinic - III)

Neenah, WI · On-site

$19.25 - $25.75/hr

Audits medical record documentation and educates providers on documentation improvement ... risk adjustment diagnosis) for professional services including specialty medical services, in and ...

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All JobsMedicare Risk Adjustment Audit JobsMedicare Risk Adjustment Audit Jobs in Wisconsin

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 Wisconsin?

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

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

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

What cities in Wisconsin are hiring for Medicare Risk Adjustment Audit jobs?

Cities in Wisconsin 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 Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, and 3% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution.

Telehealth Nurse Practitioner

Doist

Madison, WI • On-site

$110.70 - $132.84/hr

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Work from home and earn $600-$720 per day delivering telehealth visits on your schedule. Active Wisconsin Nurse Practitioner license required. Multi-state licenses preferred.

Role Snapshot
  • Role: Telehealth Nurse Practitioner
  • Location/Type: Wisconsin - Remote (No travel)
  • Pay: $600-$720/day (1099 contractor, based on efficiency)
  • Schedule: Minimum 24 hours/week - Flexible scheduling
Preferred Availability

We are looking for providers who can consistently work weekday/daytime hours, with Thursday and Friday availability strongly preferred.

What You’ll Do
  • Conduct Comprehensive Health Assessments via telehealth
  • Document risk adjustment (HCC coding) during patient visits
  • Close HEDIS care gaps during visits
  • Review medical history, medications, and preventive needs
  • Document visits using ICD-10 and CPT II codes
  • Deliver clear care plans and follow-up guidance
  • Maintain accurate visit documentation for quality programs
Must-Haves
  • Active Wisconsin Nurse Practitioner license
  • Multi-state NP licenses preferred
  • 1+ year Family Medicine or Internal Medicine experience
  • Experience with Medicare and Medicaid populations
  • Familiar with HEDIS and risk adjustment workflows
  • Medicare and Medicaid provider enrollment required
  • Comfortable delivering care through telehealth platforms
  • Ability to consistently work weekday/daytime hours, with Thursday and Friday availability preferred
Nice to Have
  • Value-based care model experience
  • Annual Wellness Visit experience
  • HCC risk adjustment documentation experience
Perks & Pay
  • Pay: $600-720 daily earning potential
  • 1099 contractor flexibility
  • Fully remote work - no commute
  • Consistent visit flow and structured workflows
  • Clear documentation processes
  • Schedule & Setup Minimum 24 hours weekly
  • Flexible scheduling based on availability
  • Weekday/daytime availability preferred, especially Thursdays and Fridays
  • Fully remote telehealth delivery
  • No on-call and no travel
Impact & Growth

Your work expands preventive care access for Medicare and Medicaid members. You help close care gaps and improve quality scores across populations. You like pace and ownership. You start, finish, follow through.

At Urrly, fairness matters. We use AI to review every application against the same clear requirements for the role. This means every candidate is evaluated on job-related factors like skills, certifications, and experience—not on personal attributes such as gender, race, age, or background. Our goal is create a more objective, consistent, and equal opportunity hiring process for all applicants.

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