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Medicare Risk Adjustment Auditor Jobs (NOW HIRING)

ChenMed, LLC

Senior Director, Risk Adjustment

Miami, FL · On-site

Trains Risk Adjustment Education, Auditing, & Coding teams to educate clinicians on documentation ... A minimum of two (2) years' experience in Coding and Medicare Risk Adjustment required * Managerial ...

Strive Health

Risk Adjustment Coder

Denver, CO · Remote

$27.88 - $32.21/hr

From AAPC or AHIMA. * 5+ years combined of related education, coding/auditing experience, or ... Extensive knowledge of documentation and coding guidelines established by the Center for Medicare ...

Strive Health

Risk Adjustment Coder

Denver, CO · On-site

$19.25 - $25.75/hr

From AAPC or AHIMA. * 5+ years combined of related education, coding/auditing experience, or ... Extensive knowledge of documentation and coding guidelines established by the Center for Medicare ...

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Medicare Risk Adjustment Auditor information

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$46

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

As of Jun 10, 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.

Risk Adjustment Specialist

LSMA Management Inc

San Bernardino, CA • On-site, Remote

$30 - $34/hr

Other

Posted 26 days ago

Job description

Description

JOB SUMMARY

The Risk Adjustment Specialist - Coding Compliance supports the organization's delegated Risk Adjustment and Coding Compliance programs by performing specialized audit support, documentation review coordination, coding validation support, medical record analysis, and compliance activities to promote accurate and complete Hierarchical Condition Category (HCC) capture in accordance with Centers for Medicare & Medicaid Services (CMS), California Department of Managed Health Care (DMHC), National Committee for Quality Assurance (NCQA), Office of Inspector General (OIG), and contracted health plan requirements.

This role supports coding compliance oversight activities related to Medicare Advantage Risk Adjustment, Risk Adjustment Data Validation (RADV), provider documentation integrity, and coding accuracy initiatives. The position assists with identifying documentation gaps, monitoring coding compliance trends, coordinating audit preparation activities, and supporting provider education efforts to ensure accurate Risk Adjustment Factor (RAF) scoring and regulatory compliance.

The Risk Adjustment Specialist collaborates closely with Coding Compliance leadership, certified coders, providers, population health teams, utilization management, care management, quality improvement, and health plans to support compliant documentation and coding practices, audit readiness, and delegated risk adjustment program performance.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS:


Education/Training

Minimum: High school diploma or GED equivalent required

Preferred: Associate's degree or higher in healthcare administration, public health, social services, or related field. 

Experience 

Minimum: At least one year of experience in one or more of the following areas: risk adjustment, coding compliance, medical record review, managed care, healthcare administration, managed care or MSO environment, medical office or provider operations.

Preferred: Experience supporting Medicare Advantage Risk Adjustment programs. Experience supporting CMS RADV audits or coding compliance audits. Experience in an MSO, IPA, health plan, delegated entity, or managed care environment. Experience working with electronic health records, coding software, or Risk Adjustment platforms.

Certification(s)

Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or other coding certification preferred.

Skills, Knowledge & Abilities

  • Knowledge of CMS Risk Adjustment methodology, HCC documentation requirements, and RAF score principles. 
  • Understanding of Medicare Advantage Risk Adjustment, coding compliance, and documentation integrity requirements. 
  • Familiarity with CMS RADV audit standards, DMHC regulatory requirements, NCQA standards, and delegated health plan oversight requirements. 
  • Ability to identify documentation deficiencies, coding inconsistencies, compliance risks, and audit-related concerns. 
  • Strong organizational, analytical, auditing, and data tracking skills with exceptional attention to detail and accuracy. 
  • Ability to maintain accurate records, audit logs, compliance documentation, and reporting tools. 
  • Proficiency with electronic health records, Risk Adjustment platforms, coding software, and Microsoft Office applications. 
  • Strong verbal and written communication skills with the ability to communicate professionally with providers, coders, leadership, health plans, and interdisciplinary teams. 
  • Ability to handle confidential and sensitive information in compliance with HIPAA and organizational policies. 
  • Ability to manage multiple priorities, deadlines, and audit-related activities in a fast-paced managed care environment.
  • Ability to work independently while collaborating effectively within interdisciplinary operational and compliance teams.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Primarily sedentary work involving prolonged computer use. Occasional standing, walking, and local travel may be required. Ability to lift up to 20 pounds occasionally. Requires strong attention to detail, data analysis capability, and effective communication skills. Work is performed in an office or remote environment supporting electronic medical record and Risk Adjustment systems.


PAY RANGE

$30.00 - $34.00 / hourly

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