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Medicare Risk Adjustment Auditor Jobs (NOW HIRING)

LSMA Management Inc

Medicare Provider Advocate

Fresno, CA · On-site

$36.05 - $38.46/hr

The Medicare Provider Advocate supports the implementation, execution, and optimization of Risk Adjustment strategies across the LaSalle provider network. This role collaborates with internal teams ...

Strive Health

Risk Adjustment Coder

Denver, CO · On-site +1

$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 ...

LSMA Management Inc

Medicare Provider Advocate

Fresno, CA · On-site

$36.05 - $38.46/hr

The Medicare Provider Advocate supports the implementation, execution, and optimization of Risk Adjustment strategies across the LaSalle provider network. This role collaborates with internal teams ...

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 ...

US Tech Solutions

Medical Billing Coder

Wellesley, MA · Remote

$20.50 - $27.50/hr

... Medicare Advantage and Commercial Risk adjustment supplemental diagnosis capture, Medicare and Commercial RADV support, and the auditing of Client's medical chart retrieval and coding vendors.

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA

$137K - $184K/yr

Provides executive oversight of all risk adjustment programs across Medicare Advantage, Medicaid, and ACA Marketplace lines of business, ensuring alignment of operational activities with ...

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site +1

$137K - $184K/yr

Provides executive oversight of all risk adjustment programs across Medicare Advantage, Medicaid, and ACA Marketplace lines of business, ensuring alignment of operational activities with ...

Mercor

HCC Coding Leader - Risk Adjustment

New York, NY · Remote

$110/hr

Lead risk adjustment and HCC coding operations across Medicare Advantage , Medicaid , and ACA risk adjustment programs. * Evaluate AI-generated HCC coding assignments and risk adjustment ...

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Vertek Staffing

HCC Risk Adjustment Coder

Franklin, TN · Remote

$18 - $24/hr

HCC / Risk Adjustment Coder - Remote Risk Adjustment / HCC Coding Experience Required Required ... Experience with Medicare Advantage populations * Experience with value-based care programs

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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 Jul 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.

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 100% Full Time. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.

Medicare Provider Advocate

LSMA Management Inc

Fresno, CA • On-site

$36.05 - $38.46/hr

Other

Posted 16 days ago

Job description

Job Type
Full-time
Description
JOB SUMMARY:
The Medicare Provider Advocate supports the implementation, execution, and optimization of Risk Adjustment strategies across the LaSalle provider network. This role collaborates with internal teams, health plan partners, and provider offices to ensure accurate, timely, and compliant capture of risk adjustment data.
The position serves as a key resource for education, performance monitoring, and operational support related to Medicare Risk Adjustment initiatives, with regular field engagement and cross-functional coordination.
Requirements
MINIMUM & PREFERRED QUALIFICATIONS:
Education/Training
Minimum: High School Diploma or equivalent.
Preferred: Associate's or Bachelor's degree in healthcare, business, or related field
Experience
Minimum: Two (2) years of experience in healthcare or health plan experience.
Preferred: Experience in Risk Adjustment, healthcare analytics, or managed care. Experience working with provider groups and/or Medicare populations.
Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
Certification(s)
Certification in Coding, Billing, or Risk Adjustment Coding (e.g., CPC, CRC, CCS or equivalent) required.
Skills, Knowledge & Abilities
• Knowledge of Risk Adjustment principles, coding guidelines, and regulatory requirements
• Understanding of Medicare data collection, encounter data, and reporting processes
• Strong analytical and problem-solving skills with the ability to manage complex issues
• Excellent organizational skills with the ability to prioritize and manage multiple tasks
• Proficiency in Microsoft Office and general computer applications
• Strong written and verbal communication skills
• Ability to build effective working relationships with internal and external stakeholders
• Ability to work independently with minimal supervision
• Valid driver's license and ability to travel using personal vehicle
PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:
The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. The role requires frequent travel to provider offices and operational sites, along with the ability to sit, stand, and walk for extended periods. The position involves regular use of standard office equipment and computer systems, as well as the ability to manage multiple priorities in a fast-paced environment. The individual must be able to work standard business hours (8:00 AM - 5:00 PM) with flexibility as needed.
PAY RANGE
$36.05 - $38.46 / hourly
Salary Description
$36.05 - $38.46 / hourly

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