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Medicare Risk Adjustment Auditor Jobs (NOW HIRING)

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

Description Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester ... Risk Adjustment activities. This position is responsible for the strategy, execution and ...

Cano Health

Auditor, ACO Coding

Miami, FL

$26 - $29.75/hr

Job Summary The ACO Coding Auditor is responsible for reviewing medical records and identifying ... CPC, CRC, CCS-P, CCS-H, RHIT * 3+ years of Medicare Risk Adjustment experience * Experience working ...

Cano Health

Auditor, ACO Coding

Miami, FL · On-site

$26 - $29.75/hr

Job Summary The ACO Coding Auditor is responsible for reviewing medical records and identifying ... CPC, CRC, CCS-P, CCS-H, RHIT * 3+ years of Medicare Risk Adjustment experience * Experience working ...

Cano Health

Auditor, ACO Coding

Miami, FL · On-site

$70 - $90/hr

Job SummaryThe ACO Coding Auditor is responsible for reviewing medical records and identifying ... CPC, CRC, CCS-P, CCS-H, RHIT3+ years of Medicare Risk Adjustment experienceExperience working in ...

ClinDCast LLC

Risk Adjustment Coding Auditor

Albany, NY · Remote

$30 - $35/hr

We are seeking a Risk Adjustment Coding Auditor with 8+ years of experience to support first- and second-pass audits for CMS RADV (Risk Adjustment Data Validation) projects. The ideal candidate must ...

ClinDCast LLC

Risk Adjustment Coding Auditor

Albany, NY · Remote

$27 - $30.75/hr

We are seeking a Risk Adjustment Coding Auditor with 8+ years of experience to support first- and second-pass audits for CMS RADV (Risk Adjustment Data Validation) projects. The ideal candidate must ...

ClinDCast LLC

Risk Adjustment Coding Auditor

Albany, NY · Remote

$27 - $30.75/hr

We are seeking a Risk Adjustment Coding Auditor with 8+ years of experience to support first- and second-pass audits for CMS RADV (Risk Adjustment Data Validation) projects. The ideal candidate must ...

Vytwo

Risk Adjustment Coding Auditor

Prosper, TX · On-site

$25 - $28.50/hr

Risk Adjustment Coding Auditor Quantity of resources: 2 Duration: 6 months JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS RADV'

Vytwo

Risk Adjustment Coding Auditor

Dallas, TX · On-site

$60 - $90/hr

Risk Adjustment Coding Auditor. Quantity of resources: 2. Duration: 6 months. JD: This role will be occupied by a certified risk adjustment coder to support first and second pass auditing for CMS ...

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Medicare Risk Adjustment Auditor information

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

As of Sep 3, 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.

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?

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 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 $39,947 per year, or $19.2 per hour.

Manager, Risk Adjustment

Mass Advantage

Worcester, MA • On-site

Full-time

Re-posted 20 days ago

Key responsibilities

  • Oversee the strategy, execution, and performance of Medicare risk adjustment programs, including prospective and retrospective activities.

  • Lead RADV audit readiness, response, and compliance activities, including medical record retrieval and validation.

  • Build and maintain analytics dashboards, KPIs, and reporting to monitor risk score accuracy, coding yield, and program ROI.

Job description

Description

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients' needs in mind.


We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.


Essential Duties and Responsibilities:

Program Strategy & Execution

  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance

  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support

  • Build and maintain the RA analytics layer - dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership

  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed. 

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.


Requirements

  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired. 
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the  V24-V28  transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).


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