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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 ...

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School Experience: 2-5 years of risk adjustment coding E/M procedures and diagnosis experience ...

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Oversee Medicare DSNP Risk Adjustment strategy and execution. * Directly support key operational initiatives to ensure program stability and scalability. Minimum Education and Experience ...

Aquity Solutions

Director Risk Adjustment - Remote

$130K - $150K/yr

... RADV audit readiness. * Product & Technology Collaboration: Partner cross-functionally with the ... Expert-level understanding of the end-to-end CMS-HCC Medicare risk coding model, including ...

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 ...

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All JobsMedicare Risk Adjustment Audit Jobs

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.
Associate Director, Risk Adjustment Data and Analytics

Associate Director, Risk Adjustment Data and Analytics

Blue Cross and Blue Shield of Massachusetts, Inc.

Boston, MA

$151K - $184K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 21 days ago

Job description

Ready to help us transform healthcare? Bring your true colors to blue. 

The Role

Director of Risk Adjustment Data and Analytics

Under the direction of the Senior Directory of Medicare Risk Adjustment and Analytics, the Director of Risk Adjustment Data and Analytics is responsible for developing and executing the analytic plan for the Medicare and Merged Market segments. The Director of Risk Adjustment Data and Analytics will oversee the reporting, analytics and management of risk adjustment, internally and externally. The role is responsible for the strategy, execution and performance of Medicare risk adjustment reporting and analytics, infrastructure and systems to meet business objectives, partnership with Actuarial and Provider Contracting, management of external vendors, and compliance with CMS regulations. This leader is responsible for analysis, projections, and assessment of risk adjustment performance.

RESPONSIBILITIES:

  • Responsible for direct leadership of the Risk Adjustment Performance and Strategic Analytics Team and the Risk Adjustment Data and Analytics Team
  • Design and develop metrics, reports, and dashboards to drive key strategic and tactical decisions, ensuring alignment of resources as needed, and balance workloads
  • Coordinate risk adjustment analytics throughout the broader organization
  • Investigate risk adjustment trends across all areas including enrollment, providers and claims to suggest business improvements and efficiencies
  • Represent the Risk Adjustment Team on internal workgroups and committees focused on reporting, analytics, and operations
  • Ensure business deliverables are being met and risk adjustment data is provided to Government Programs leaders and internal business leaders to inform strategic initiatives
  • Act as the primary contact for facilitating resolution (via analysis and reporting) on urgent issues and/or issues escalated by risk adjustment leaders.
  • Drive innovation and improvements through deep dive analytics; improve risk adjustment processes; increase efficiency and productivity and improve overall plan performance
  • Oversee the assessment of reporting requests, compilation, and distribution of routine and ad hoc reports for internal and external constituents
  • Coach, mentor, and develop analytic team members to increase their skill sets, enhance their subject matter knowledge, and improve their effectiveness to support other business areas
  • Oversee submission of BCBSMA's Encounter Data submission to CMS and resolution of errors
  • Represent the Risk Adjustment Team's interests through influence and negotiation in cross-functional workgroups that have a technology focus, are strategic around risk adjustment data and systems, or pertain to new projects.

QUALIFICATIONS:

  • Excellent knowledge of Medicare risk adjustment model
  • Knowledge of Medicare and risk adjustment data and system interfaces required
  • SAS/SQL experience required. Other experience with the use of software for data analysis, extraction, and manipulation (e.g., Python, R), data visualization (e.g., Tableau) and analytic automation (e.g. scripting, macros) preferred
  • Demonstrated attention to detail, delivering quality results and operating collaboratively as part of a team
  • Experience in managing technology-related projects with vendors, IT and corporate partners
  • Proven success in managing people and achieving business goals and objectives
  • Ability to develop strong working relationships and to influence key internal constituents to
  • Documented strength in analysis, identification of problems, and problem resolution
  • Proven track record of meeting timelines, deliverables, attention to detail and quality results
  • Strong organizational skills with ability to work under pressure, multitask and prioritize workload
  • Ability to identify, communicate, and manage risk
  • Effective presentation, facilitation, project management and planning skills

EDUCATION/RELEVANT EXPERIENCE:

  • Bachelor's degree required; Master's degree preferred
  • A minimum of 7 years of Medicare risk adjustment experience
  • Minimum 5 years of progressive leadership experience preferred
  • Project Management and IT experience a plus
  • Must be highly organized and capable of handling a multitude of projects at once
Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

LocationBoston, HinghamTime TypeFull timeSalary Range: $151,200.00 - $184,800.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.

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