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Medicare Risk Adjustment Auditor Jobs (NOW HIRING)

Regal Medical Group, Inc.

$25 - $27/hr

The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding ...

Regal Medical Group, Inc.

$33 - $36/hr

The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding ...

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$10

$19

$46

How much do medicare risk adjustment auditor jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for medicare risk adjustment auditor in the United States is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $14.42 and $19.23 per hour, depending on experience, location, and employer.

How does a Medicare Risk Adjustment Auditor typically 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 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.

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 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?

AspectMedicare Risk Adjustment AuditorMedicare Data Analyst
CertificationsTypically requires certifications like RHIA or RACMay hold certifications like CPC or data analysis credentials
Work EnvironmentFocuses on auditing medical records and coding accuracyAnalyzes Medicare data trends and reports
Employer & IndustryHealthcare providers, insurance companies, government agenciesHealthcare 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.

More about Medicare Risk Adjustment Auditor jobs
What states have the most Medicare Risk Adjustment Auditor jobs? States with the most job openings for Medicare Risk Adjustment Auditor jobs include:
What job categories do people searching Medicare Risk Adjustment Auditor jobs look for? The top searched job categories for Medicare Risk Adjustment Auditor jobs are:
Medicare Risk Adjustment Auditor jobs near you
Infographic showing various Medicare Risk Adjustment Auditor job openings in the United States as of June 2026, with employment types broken down into 67% Full Time, and 33% Contract. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.
Associate Director, Risk Adjustment Data and Analytics

Associate Director, Risk Adjustment Data and Analytics

Blue Cross Blue Shield of Massachusetts

Boston, MA • On-site

$151K - $184K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

Blue Cross Blue Shield of Massachusetts rating

9.1

Company rating: 9.1 out of 10

Based on 23 frontline employees who took The Breakroom Quiz

23rd of 260 rated insurance

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
Location
Boston, HinghamTime Type
Full time
Salary 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 the confidence gap and imposter syndrome can 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 our Company Culture page. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join our Talent Community to 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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