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Medicare Risk Adjustment Auditor Jobs (NOW HIRING)

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School Experience: 2-5 years of risk adjustment coding E/M procedures and diagnosis experience ...

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...

Molina Healthcare

Auditor, Risk Adjustment (Remote)

$49K - $107K/yr

... Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data. • Identifies opportunities for data mining to ensure data gaps are minimized. • Applies best practices to ...

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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Medicare Risk Adjustment Auditor information

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

As of Aug 12, 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 do you become a Medicare Risk Adjustment Auditor?

To become a Medicare Risk Adjustment Auditor, candidates typically need a background in healthcare, coding, or medical billing, along with knowledge of Medicare policies. Relevant certifications such as CPC or CRC can enhance prospects, and experience with medical records review and data analysis is valuable. Employers often require strong attention to detail and familiarity with auditing tools and compliance standards.

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 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?

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 100% Full Time. Highlights an 33% In-person, and 67% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.

RISK ADJUSTMENT FACTOR SPECIALIST (2566)

VIVANT HEALTH

Sacramento, CA • On-site

$28 - $34/hr

Full-time

Re-posted 2 days ago

Job description

Job Summary:

The Risk Adjustment Factor (RAF) Specialist supports Vivant’s risk adjustment initiatives within the IPA’s Medicare Advantage line of business. This role ensures accurate and complete documentation and coding of diagnoses to optimize member Risk Adjustment Factor (RAF) scores, supporting quality patient care and accurate reimbursement under CMS guidelines. The RAF Specialist collaborates closely with providers, coders, and care management teams to identify opportunities for RAF improvement through education, chart reviews, and data analysis.

Responsibilities:

  • Review and analyze clinical documentation and diagnosis coding to ensure compliance with CMS-HCC (Hierarchical Condition Category) guidelines.
  • Monitor and report RAF score trends across assigned providers, physician groups, and Medicare populations.
  • Conduct retrospective and prospective chart reviews to identify coding gaps, suspected conditions, and missed opportunities.
  • Partner with provider offices to ensure accurate submission of encounter data and supplemental claims.
  • Work collaboratively with health plan and IPA coding teams to reconcile risk score discrepancies and validate data accuracy.
  • Support provider education programs on compliant documentation and coding practices (HCC, ICD-10, and CMS Risk Adjustment methodology).
  • Compile RAF performance dashboards and support audit and reconciliation processes related to Medicare risk adjustment.
  • Participate in outreach campaigns to ensure timely completion of annual wellness visits and other risk-capture opportunities.
  • Stay current with CMS updates, HCC model changes, and risk adjustment regulatory requirements.
  • Assist in developing workflow improvements for documentation, coding, and data submission.
  • Performs related duties consistent with the scope and intent of the position.
  • Regular attendance.
  • Travel as required.
  • Other Functions
  • Enforces Company policies and safety procedures.
  • Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
  • Maintain IPA, Health Plan compliance standards.

Competencies

  • Minimum of 2–3 years of experience in Risk Adjustment, HCC coding, or Medicare Advantage operations.
  • 2-3 years of Independent Physician Association (IPA) or health plan environment preferred.
  • Cozeva experience preferred.
  • Strong knowledge of ICD-10, HCC risk adjustment models, CMS guidelines, and Medicare Advantage programs.
  • Proficiency in EMR/EHR systems, risk adjustment analytics platforms, and Microsoft Office Suite (Excel, Power BI preferred).
  • Ability to analyze data, identify trends, and develop actionable insights.
  • Excellent communication, both oral and written, and interpersonal skills for provider education and collaboration.
  • Excellent attention to detail and ability to document information accurately.
  • Excellent active listening skills.
  • Ability to solve mid-level problems with minimal supervision.
  • Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
  • Ability to provide and receive constructive job and/or industry related feedback.
  • Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
  • Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
  • Ability to consistently deliver excellent customer service.
  • Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
  • Ability to work independently as well as in a team environment.
  • Ability to present self in a professional manner and represent the Company image.
  • Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
  • Demonstrate commitment to the organization’s mission.
  • Typing speed of 40 wpm or more is a plus.
  • Must have the ability to quickly learn and use new software tools.
  • Must have mid-level skills using e-mail applications.

Travel

  • The incumbent may travel up to 25% of the time.

Competencies

  • Minimum of 2–3 years of experience in Risk Adjustment, HCC coding, or Medicare Advantage operations.
  • 2-3 years of Independent Physician Association (IPA) or health plan environment preferred.
  • Cozeva experience preferred.
  • Strong knowledge of ICD-10, HCC risk adjustment models, CMS guidelines, and Medicare Advantage programs.
  • Proficiency in EMR/EHR systems, risk adjustment analytics platforms, and Microsoft Office Suite (Excel, Power BI preferred).
  • Ability to analyze data, identify trends, and develop actionable insights.
  • Excellent communication, both oral and written, and interpersonal skills for provider education and collaboration.
  • Excellent attention to detail and ability to document information accurately.
  • Excellent active listening skills.
  • Ability to solve mid-level problems with minimal supervision.
  • Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
  • Ability to provide and receive constructive job and/or industry related feedback.
  • Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
  • Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
  • Ability to consistently deliver excellent customer service.
  • Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
  • Ability to work independently as well as in a team environment.
  • Ability to present self in a professional manner and represent the Company image.
  • Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
  • Demonstrate commitment to the organization’s mission.
  • Typing speed of 40 wpm or more is a plus.
  • Must have the ability to quickly learn and use new software tools.
  • Must have mid-level skills using e-mail applications.

Education and Certification

  • High School Diploma or GED required.
  • Associate’s or Bachelor’s degree in Health Information Management, Health Administration, Nursing, or related field preferred.
  • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent credential required.
  • Must have an active and unrestricted California Driver’s license.
  • Must have auto insurance and reliable transportation.

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