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Medicare Risk Adjustment Audit Jobs (NOW HIRING)

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

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 ...

Cano Health

Auditor, ACO Coding

Miami, FL · On-site

$26 - $29.75/hr

Participates in audits and analyzes data to identify trends and improvement opportunities ... CPC, CRC, CCS-P, CCS-H, RHIT * 3+ years of Medicare Risk Adjustment experience * Experience working ...

Cano Health

Auditor, ACO Coding

Miami, FL

$26 - $29.75/hr

Participates in audits and analyzes data to identify trends and improvement opportunities ... CPC, CRC, CCS-P, CCS-H, RHIT * 3+ years of Medicare Risk Adjustment experience * Experience working ...

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

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 ...

Mercor

Risk Adjustment Expert - AI Trainer

Nashville, TN · 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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All JobsMedicare Risk Adjustment Audit Jobs

Medicare Risk Adjustment Audit information

See salary details

$31K

$89.7K

$126.5K

How much do medicare risk adjustment audit jobs pay per year?

As of Sep 1, 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 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.

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 August 2026, with employment types broken down into 1% As Needed, 89% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $89,650 per year, or $43.1 per hour.

Risk Adjustment - Risk Adjustment Program Manager 135-2008

Tulsa, OK • On-site

CommunityCare
See more jobs at CommunityCareexternal

Full-time

Re-posted 8 days ago

Job description

JOB SUMMARY: Responsible for overseeing the day-to-day execution, performance, and optimization of the risk adjustment program across vendor management, medical record retrieval, coding quality, analytics, reporting, and audit readiness. This role drives process improvement, monitors operational and financial performance, ensures compliance with CMS and organizational requirements, and supports retrospective and prospective risk adjustment initiatives.
KEY RESPONSIBILITIES:
  • Oversee daily risk adjustment operations and ensure efficient execution across program workflows.
  • Identify process gaps and implement improvements across retrieval, coding, reporting, vendor operations, and data workflows.
  • Establish, monitor, and manage key performance indicators to track operational performance, RAF performance, coding accuracy, retrieval rates, and vendor outcomes.
  • Manage risk adjustment vendors for coding, retrieval, analytics, and prospective programs, ensuring SLA adherence and coding accuracy standards.
  • Oversee vendor audits, corrective action plans, and monthly invoice reconciliation against performance and contractual requirements.
  • Lead medical record retrieval strategies to improve chart capture rates, reduce turnaround times, and address low-performing provider sites.
  • Oversee coding quality assurance processes, including vendor over-reads, internal audits, and compliance with CMS guidelines and organizational policies.
  • Coordinate RADV audit readiness activities, including record retrieval, submission tracking, audit response, documentation, and regulatory review preparation.
  • Analyze audit results, data issues, and process gaps to identify root causes and implement operational improvements.
  • Oversee retrospective chart reviews and prospective engagement programs to support suspect capture, gap closure, new member engagement, and program effectiveness.
  • Partner with analytics teams to develop dashboards, reporting, vendor scorecards, ROI analysis, WNRAR reporting, and actionable leadership insights.
  • Collaborate cross functionally to resolve issues, improve reporting accuracy, support submissions, and streamline risk adjustment operations.
  • Perform other job related duties as required or assigned.

QUALIFICATIONS:
  • Strong understanding of Medicare Advantage and ACA risk adjustment models (CMS-HCC and HHS-HCC) and RADV analytics.
  • Experience managing vendors and holding performance accountability.
  • Proven knowledge of CMS guidelines, RADV audits, and coding processes.
  • Proven ability to lead cross-functional initiatives and process improvement efforts.
  • Experience with reporting tools, dashboards, and data-driven decision-making.
  • Excellent written and verbal communication skills, including presenting to senior leadership.
  • Successful completion of Health Care Sanctions background check.

EDUCATION/EXPERIENCE:
  • Bachelor's degree in analytics, statistics, health informatics, business, or related field, with a minimum of three (3) years of healthcare analytics, risk adjustment, or population health experience.
  • CRC, CPC, or other relevant licenses required.
  • Prior experience supporting production planning.
  • Prior experience with RAF projections preferred.
  • Prior experience with prospective programs and provider engagement models preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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