... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
New
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
New
Medical Coding Specialist II - Ophthalmology & Multi Specialty
Middleton, WI · On-site
$28.21 - $42.32/hr
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
Medical Coding Specialist II - Ophthalmology & Multi Specialty
Middleton, WI · On-site
$28.21 - $42.32/hr
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment ...
Coding Auditor
Appleton, WI · On-site
$26.50 - $30.25/hr
... Medicare and Medicaid (CMS) guidelines. Provides ongoing feedback and analysis of the education ... Responds to identified areas of risk through investigation and internal audit to ensure compliance ...
Coding Auditor
Appleton, WI · On-site
$26.50 - $30.25/hr
... Medicare and Medicaid (CMS) guidelines. Provides ongoing feedback and analysis of the education ... Responds to identified areas of risk through investigation and internal audit to ensure compliance ...
Coding Auditor
Appleton, WI · On-site
$26 - $29.50/hr
... Medicare and Medicaid (CMS) guidelines. Provides ongoing feedback and analysis of the education ... Responds to identified areas of risk through investigation and internal audit to ensure compliance ...
Coding Auditor
Appleton, WI · On-site
$26 - $29.50/hr
... Medicare and Medicaid (CMS) guidelines. Provides ongoing feedback and analysis of the education ... Responds to identified areas of risk through investigation and internal audit to ensure compliance ...
Clinician Coding Liaison - ENT / Audiology
Milwaukee, WI · Remote
$35.50 - $53.25/hr
Collaborate across departments-including CMOs, Clinical Informatics, Risk Adjustment, and ... Ensure compliance with regulatory standards, including Medicare, Medicaid, and AHIMA's Standards of ...
Clinician Coding Liaison - ENT / Audiology
Milwaukee, WI · Remote
$35.50 - $53.25/hr
Collaborate across departments-including CMOs, Clinical Informatics, Risk Adjustment, and ... Ensure compliance with regulatory standards, including Medicare, Medicaid, and AHIMA's Standards of ...
Clinical Provider Auditor II - Payment Integrity SIU
Waukesha, WI · On-site
$58K - $107K/yr
Recommends possible interventions for loss control and risk avoidance based on the outcome of the ... Prepay review of Medicare and Medicaid experience highly desired. * Knowledge of ICD-10 and CPT ...
Clinical Provider Auditor II - Payment Integrity SIU
Waukesha, WI · On-site
$58K - $107K/yr
Recommends possible interventions for loss control and risk avoidance based on the outcome of the ... Prepay review of Medicare and Medicaid experience highly desired. * Knowledge of ICD-10 and CPT ...
Clinical Provider Auditor II - Payment Integrity SIU
Waukesha, WI · On-site
$58K - $107K/yr
Recommends possible interventions for loss control and risk avoidance based on the outcome of the ... Prepay review of Medicare and Medicaid experience highly desired. * Knowledge of ICD-10 and CPT ...
Clinical Provider Auditor II - Payment Integrity SIU
Waukesha, WI · On-site
$58K - $107K/yr
Recommends possible interventions for loss control and risk avoidance based on the outcome of the ... Prepay review of Medicare and Medicaid experience highly desired. * Knowledge of ICD-10 and CPT ...
WI · On-site
$100 - $125/hr
... risk adjustment, network adequacy, access, and growth initiatives, while ensuring consistent ... Medicare Advantage experience in a Provider Relations or similar role * Experience working with ...
WI · On-site
$100 - $125/hr
... risk adjustment, network adequacy, access, and growth initiatives, while ensuring consistent ... Medicare Advantage experience in a Provider Relations or similar role * Experience working with ...
... risk for fraud and abuse. Includes, but is not limited to ... The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage ...
... risk for fraud and abuse. Includes, but is not limited to ... The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage ...
Coder (Clinic - II)
Neenah, WI · On-site
$19.25 - $25.75/hr
Reviews and/or assigns CPT and/or diagnosis codes (ICD-10-CM, including HCC risk adjustment) for ... Performs documentation reviews with the use of department auditing tools, shares results with ...
Coder (Clinic - II)
Neenah, WI · On-site
$19.25 - $25.75/hr
Reviews and/or assigns CPT and/or diagnosis codes (ICD-10-CM, including HCC risk adjustment) for ... Performs documentation reviews with the use of department auditing tools, shares results with ...
Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...
Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...
Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...
Company Description Altegra Health is a total solutions partner for healthcare data auditing and ... Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ...
WI · On-site
$80 - $100/hr
... Mind Over Risk" philosophy. More than an insurance company, we are an organization built on ... adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the ...
WI · On-site
$80 - $100/hr
... Mind Over Risk" philosophy. More than an insurance company, we are an organization built on ... adjustments, where applicable. The pay range is the range THMCC, in good faith, believes is the ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Reimbursement Analysis - REMOTE
Milwaukee, WI · Remote
$33.05 - $49.60/hr
Requests adjustments from United Government Services (UGS) and updates internal systems. * Develops ... Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal ...
Reimbursement Analysis - REMOTE
Milwaukee, WI · Remote
$33.05 - $49.60/hr
Requests adjustments from United Government Services (UGS) and updates internal systems. * Develops ... Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Financial Counselor
Madison, WI · On-site
$19 - $24.75/hr
Responsible for auditing the admission packets and for the verification of benefits along with all ... Complete adjustment forms for any charity or administrative adjustments for approval. * Complete ...
Medicare Risk Adjustment Auditor information
See Wisconsin salary details
$10.43 - $13.74
15% of jobs
$14.47 is the 25th percentile. Wages below this are outliers.
$13.74 - $17.05
46% of jobs
$18.80 is the 75th percentile. Wages above this are outliers.
$17.05 - $20.36
26% of jobs
$20.36 - $23.67
7% of jobs
$23.67 - $26.98
1% of jobs
$26.98 - $30.29
1% of jobs
$30.29 - $33.59
1% of jobs
$33.59 - $36.90
0% of jobs
$36.90 - $40.21
1% of jobs
$40.21 - $43.52
1% of jobs
$43.52 - $46.83
0% of jobs
$10
$19
$46
How much do medicare risk adjustment auditor jobs pay per hour?
As of Sep 7, 2026, the average hourly pay for medicare risk adjustment auditor in Wisconsin is $19.39, according to ZipRecruiter salary data. Most workers in this role earn between $14.57 and $19.42 per hour, depending on experience, location, and employer.
What is a Medicare Risk Adjustment Auditor?
A Medicare Risk Adjustment Auditor is a healthcare professional responsible for reviewing and validating medical records to ensure accurate documentation and coding of patient diagnoses for Medicare Advantage plans. Their work ensures that healthcare providers and organizations receive appropriate reimbursement based on the health status of their patient population. Auditors analyze clinical documentation, verify that diagnoses meet CMS (Centers for Medicare & Medicaid Services) guidelines, and help identify areas for improvement in coding practices. The goal is to maintain compliance with federal regulations and optimize risk adjustment scores to reflect the true complexity of patient care.
How does a Medicare Risk Adjustment Auditor collaborate with healthcare providers to ensure accurate coding and reporting?
Medicare Risk Adjustment Auditors work closely with healthcare providers, coders, and clinical staff to review and validate medical records for proper diagnosis coding. This collaboration often involves providing feedback, conducting training sessions on documentation best practices, and clarifying complex coding guidelines. Auditors may also participate in regular meetings with provider groups to discuss audit findings and recommend improvements, fostering a team-oriented approach to compliance and quality reporting. Effective communication and partnership are essential in helping providers understand regulations and improve documentation accuracy.
What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Auditor?
To thrive as a Medicare Risk Adjustment Auditor, you need strong knowledge of medical coding (ICD-10), healthcare regulations, and experience with risk adjustment methodologies, often supported by certifications such as CRC (Certified Risk Adjustment Coder). Familiarity with auditing software, electronic health records (EHRs), and compliance tools is crucial. Analytical thinking, attention to detail, and effective communication skills help auditors spot discrepancies and work collaboratively with providers. These skills ensure accurate risk score calculations, regulatory compliance, and optimal reimbursement for healthcare organizations.
What is the difference between Medicare Risk Adjustment Auditor vs Medicare Data Analyst?
| Aspect | Medicare Risk Adjustment Auditor | Medicare Data Analyst |
|---|---|---|
| Certifications | Typically requires certifications like RHIA or RAC | May hold certifications like CPC or data analysis credentials |
| Work Environment | Focuses on auditing medical records and coding accuracy | Analyzes Medicare data trends and reports |
| Employer & Industry | Healthcare providers, insurance companies, government agencies | Healthcare organizations, insurance companies, government agencies |
Medicare Risk Adjustment Auditors primarily review medical records to ensure accurate coding for risk adjustment, while Medicare Data Analysts interpret Medicare data to identify trends and improve processes. Both roles require familiarity with Medicare regulations and data management, but their focus areas differ—auditing versus data analysis.
What are popular job titles related to Medicare Risk Adjustment Auditor jobs in Wisconsin?
For Medicare Risk Adjustment Auditor jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment Auditor jobs in Wisconsin look for?
The top searched job categories for Medicare Risk Adjustment Auditor jobs in Wisconsin are:
Other
Medical, Dental, Retirement, PTO
Posted 4 days ago
UW Health rating
7.9
Based on 227 frontline employees who took The Breakroom Quiz
111th of 898 rated healthcare providers
Job description
Medical Coding Specialist II - Ophthalmology & Multi Specialty
This is a Monday - Friday, 40 hours per week position. Hours are flexible and will be discussed in the interview process. This is a remote position.
To be eligible to work remotely, you must be in an approved remote work state for UW Health. We've included a link below to view the full list of approved remote work states.
Approved Remote Work States Listing
Be part of something remarkable
Join the #1 hospital in Wisconsin!
We are seeking a Medical Coding Specialist II to:
Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes.
Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.
At UW Health, you will have:
An excellent benefits package, including health and dental insurance, paid time off, retirement plans, two-week paid parental leave and adoption assistance.
Options for a variety of schedules and shifts that offer flexibility and allow for work-life balance.
Access to great resources through the UW Health Employee Wellbeing Department that supports your emotional, financial, and physical well-being.
Tuition benefits eligibility - UW Health invests in your professional growth by helping pay for coursework associated with career advancement.
The opportunity to earn a referral bonus for referring friends, former colleagues or others to apply for open, posted positions.
Education Qualifications
Minimum - High School diploma or equivalent and medical coding education. In lieu of a medical coding education, an active coding certification is required.
Preferred - Associate degree in a healthcare-related field.
Work Experience
Minimum - One-year of progressive coding experience.
Preferred - Two years of progressive coding experience in multiple specialties, HCC Risk adjustment Coding.
Licenses & Certifications
Minimum - Certification as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA) required, or Certified Risk Adjustment Coder (CRC) required
Preferred - Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA).
Our Commitment to Social Impact and Belonging
UW Health is committed to fostering a workplace that creates belonging for everyone and is an Equal Employment Opportunity (EEO) employer. Our respect for people shines through patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. It is the policy of UW Health to provide equal opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Job Description
UW Medical Foundation benefits
What UW Health employees say
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Benefits
Hours and flexibility
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Get the full story on Breakroom
About UW Health
Sourced by ZipRecruiter
UW Health Clinics - our physicians and staff are dedicated to providing an exceptional patient and family experience by delivering the highest quality of care in a compassionate environment. With more than 80 primary and specialty care clinics located throughout Dane County and the surrounding areas, we are proud to have the opportunity to impact the communities we serve.
Industry
Health care and social assistance and hospitals
Company size
10,000+ Employees
Headquarters location
Madison, WI, US