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Medicare Risk Adjustment Audit Jobs (NOW HIRING)

US Tech Solutions

Medical Billing Coder

Wellesley, MA · Remote

$20.50 - $27.50/hr

... of the Medicare risk adjustment retrospective initiative and Risk Adjustment Data Validation (RADV) Audits. This role will also assist with building the medical chart review program at Client ...

Honest Health

Sr. Risk Adjustment Auditor

$82K - $101K/yr

... CMS Medicare risk adjustment requirements, MEAT criteria, and HCC capture standards. The Auditor ... Audit third-party vendor coding and CDI outputs to ensure accuracy, compliance, and adherence to ...

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site

$137K - $184K/yr

Provides executive oversight of all risk adjustment programs across Medicare Advantage, Medicaid ... Develops and implements strategies to improve RADV performance, reduce audit exposure, and ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team. Oscar is the ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site +1

$137K - $184K/yr

Provides executive oversight of all risk adjustment programs across Medicare Advantage, Medicaid ... Develops and implements strategies to improve RADV performance, reduce audit exposure, and ...

Centrum Health

Risk Adjustment Analyst

Doral, FL · On-site

ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...

Vertek Staffing

HCC Risk Adjustment Coder

Franklin, TN · Remote

$18 - $24/hr

Participate in internal and external audit activities. * Stay current on CMS Risk Adjustment ... Experience with Medicare Advantage populations * Experience with value-based care programs

Mercor

HCC Coding Leader - Risk Adjustment

New York, NY · Remote

$110/hr

Lead risk adjustment and HCC coding operations across Medicare Advantage , Medicaid , and ACA risk ... Manage RADV audit preparation and response processes. * Collaborate with clinical, coding, and ...

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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 3, 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 June 2026, with employment types broken down into 2% As Needed, 45% Full Time, 48% Part Time, 1% Temporary, and 4% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $89,650 per year, or $43.1 per hour.
Medical Billing Coder

Medical Billing Coder

US Tech Solutions

Wellesley, MA • Remote

$20.50 - $27.50/hr

Full-time

Posted 6 days ago

Job description

Company Description

US Tech Solutions is a global staff augmentation firm providing a wide-range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit our website www.ustechsolutions.com.

We are constantly on the lookout for professionals to fulfill the staffing needs of our clients, sets the correct expectation and thus becomes an accelerator in the mutual growth of the individual and the organization as well.

Keeping the same intent in mind, we would like you to consider the job opening with US Tech Solutions that fits your expertise and skillset.

Job Description

Medical Record Reviewer will primarily be responsible for completing medical record reviews (on-site, remote and/or in-house) in support of the Medicare risk adjustment retrospective initiative and Risk Adjustment Data Validation (RADV) Audits. This role will also assist with building the medical chart review program at Client's

Duties and Responsibilities

  • Utilize comprehensive knowledge American Hospital Association (AHA) coding principles of CPT, HCPCS, ICD9-CM/ICD10-CM diagnosis and procedure codes to evaluate medical record documentation for HCC risk adjustment related activities including Medicare Advantage and Commercial Risk adjustment supplemental diagnosis capture, Medicare and Commercial RADV support, and the auditing of Client's medical chart retrieval and coding vendors.
  • Collect and document chart and coding information as required for Commercial Risk Adjustment and Medicare Advantage Risk Adjustment Client's data collection procedures and systems. 
  • Assist with building the medical chart review program at Client's including defining the operating policies and procedures, mentoring team members and input into infrastructure needs and organization. 
  • Utilize coding expertise to inform Revenue Management strategy development activities and may support initiatives related to coding such as provider office education.
  • Responsible for developing and maintaining internal and vendor based coding guidelines.
  • Provide subject matter expertise on projects related to coding practices including provider education and communications.
  • Prepare reports of the data gathered and received from Client's providers/members, ensuring reports are completed with the highest quality and integrity and that all work is in full compliance with Client's and Regulatory requirements.
  • Participate in all required training - maintaining of coding certification or other professional credentials
  • Completing inter-rater reliability testing as requested 
  • Abide by all HIPAA and associated patient confidentiality requirements.
  • Coordinate with third party and internal auditors as required.
  • Other duties and projects as needed.
Qualifications

Minimum Requirements

  1. Bachelor's Degree; Clinical experience or licensed nursing professional and 3-5 years related experience. RHIA, RHIT, CCS or CPC-H with demonstrated outpatient coding experience required. ICD -9/ICD-10 certification required. 
  2. Experience in performing HEDIS chart abstractions; Experience in Risk Adjustment audit HCC extraction.
  3. Experience of healthcare delivery systems is preferred. Proven project leadership skills and ability to mentor and motivate others in the team. 
  4.  Advanced PC skills (e.g., Excel, Access, etc.) required; Excellent written and verbal communication skills, customer service skills, organization and problem solving skills, research skills, and the ability to work independently.
Additional Information

Thanks & Regards

Dishant

781-684-9064

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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

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