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Medicare Risk Adjustment Audit Jobs (NOW HIRING)

LSMA Management Inc

Medicare Provider Advocate

Fresno, CA · On-site

$36.05 - $38.46/hr

The Medicare Provider Advocate supports the implementation, execution, and optimization of Risk Adjustment strategies across the LaSalle provider network. This role collaborates with internal teams ...

Strive Health

Risk Adjustment Coder

Denver, CO · Remote

$27.88 - $32.21/hr

This individual will assist in special coding audits and coding projects as necessary and provide ... Extensive knowledge of documentation and coding guidelines established by the Center for Medicare ...

LSMA Management Inc

Medicare Provider Advocate

Fresno, CA · On-site

$36.05 - $38.46/hr

The Medicare Provider Advocate supports the implementation, execution, and optimization of Risk Adjustment strategies across the LaSalle provider network. This role collaborates with internal teams ...

Strive Health

Risk Adjustment Coder

Denver, CO · On-site +1

$19.25 - $25.75/hr

This individual will assist in special coding audits and coding projects as necessary and provide ... Extensive knowledge of documentation and coding guidelines established by the Center for Medicare ...

LSMA Management Inc

Medicare Provider Advocate

Fresno, CA · On-site

$36.05 - $38.46/hr

The Medicare Provider Advocate supports the implementation, execution, and optimization of Risk Adjustment strategies across the LaSalle provider network. This role collaborates with internal teams ...

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 ...

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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 Jul 2, 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.
Risk Adjustment Compliance Project Manager

Risk Adjustment Compliance Project Manager

Medica

Minnetonka, MN • On-site

Other

Medical, Dental, Vision, Retirement, PTO

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

Medica rating

8.4

Company rating: 8.4 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

98th of 277 rated insurance

Job description

Risk Adjustment Compliance Project Manager

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Risk Adjustment Compliance Project Manager is responsible for leading compliance focused initiatives that ensure the accuracy, integrity, and regulatory adherence of Medica's Risk Adjustment programs across Medicare Advantage, Medicaid, and ACA lines of business. This role provides subject matter expertise in regulatory requirements, audit readiness, and governance, and serves as a cross functional project leader for compliance, audit, and documentation initiatives. The Risk Adjustment Compliance Project Manager plays a critical role in maintaining audit readiness, mitigating compliance risk, and ensuring risk adjustment policies, procedures, and provider education aligning with CMS and state regulations.

Key Accountabilities

  • Audit Oversight & Readiness (30%)
    • Coordinate and support internal and external audits, including RADV and other regulatory or operational reviews
    • Serve as the primary point of coordination for audit requests, documentation retrieval, validation, and submission
    • Track audit findings and collaborate with stakeholders on corrective action plans and remediation efforts
    • Support ongoing audit readiness by strengthening controls, workflows, and documentation standards
  • Policy & Procedure Management (25%)
    • Develop, maintain, and update Risk Adjustment policies, procedures, and standard operating documentation
    • Ensure documentation reflects current regulatory guidance, operational practice, and internal control requirements
    • Partner with Compliance and Operational leaders to ensure consistent application and understanding of policies
    • Maintain audit?ready documentation, including version control and governance standards
  • Risk Adjustment Compliance & Governance (20%)
    • Lead Risk Adjustment compliance initiatives to ensure adherence to CMS and state regulatory requirements
    • Interpret and operationalize regulatory guidance impacting risk adjustment documentation, submission, and oversight
    • Partner closely with Compliance, Quality, Legal, and Risk Adjustment Operations to align compliance activities with enterprise standards
    • Identify compliance risks, gaps, and trends, and drive mitigation strategies to reduce regulatory exposure
  • Provider Education & Documentation Integrity (15%)
    • Collaborate with Provider Engagement and Quality teams to support provider education related to compliant documentation and risk adjustment standards
    • Ensure provider education materials align with regulatory requirements and Medica compliance expectations
    • Act as a subject matter expert for documentation and compliance?related questions impacting providers and internal teams
  • Project Management & Continuous Improvement (10%)
    • Lead compliance?driven risk adjustment projects from planning through execution
    • Coordinate cross?functional efforts to implement regulatory changes or compliance improvements
    • Identify and implement process improvements that strengthen program integrity and operational effectiveness
    • Provide compliance status updates and reporting to leadership as needed

Required Qualifications

  • Bachelor's degree in Healthcare Administration, Business, Health Information Management, Compliance, or related field
  • 5+ years of experience in healthcare operations, risk adjustment, healthcare compliance and/or audit, or regulatory support

Preferred Qualifications

  • Experience supporting RADV or CMS or DHS compliance audits
  • Background in provider education, clinical documentation, or coding compliance
  • Experience developing and maintaining healthcare policies and procedures
  • Experience supporting Medicare Advantage, Medicaid, or ACA risk adjustment programs

Desired Skills

  • Demonstrated experience supporting regulatory and operational audits, with a strong understanding of Risk Adjustment programs and applicable CMS and state regulatory requirements
  • Proven ability to lead compliance?focused initiatives through effective project management, organization, and analytical skills
  • Excellent written and verbal communication skills, with the ability to collaborate across cross?functional teams and communicate complex regulatory requirements clearly to both technical and non?technical stakeholders

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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