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Medicare Risk Adjustment Auditor Jobs (NOW HIRING)

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.

PacificSource

Senior Risk Adjustment Analyst

Virginia, MN · On-site

$74.60 - $126.82/hr

Senior Risk Adjustment Analyst Senior Risk Adjustment (RA) Analyst assists in accurate and comprehensive data submission to regulatory entities such as the Centers for Medicare & Medicaid Services ...

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

As of Sep 2, 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.

Risk Adjustment Coder

Sentara Healthcare Inc

Virginia Beach, VA • On-site

$60 - $80/hr

Other

Posted yesterday

New

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 416 frontline employees who took The Breakroom Quiz

498th of 898 rated healthcare providers

Job description

Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA!

Hours: Monday - Friday, 8:00AM -5:00PM, dayshift.

This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week. The role also includes travel as needed to support business objectives and team collaboration.

Overview

Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training, monitoring, & auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. Performs vendor quality oversight audits; reviews and/or makes final coding determination for non-agreeable coding. Makes final decision on vendor-to-vendor diagnosis coding rebuttal concerns. Serves as subject matter expert on risk adjustment diagnosis coding guidelines. Coordinates risk adjustment gap elimination with clinical and quality gap elimination Maintains a reasonable fluency in workings & financial implications of applicable risk adjustment models.

Education
  • Associate degree (Required)
Experience
  • Medical Records Data - 1 year (Required)
  • Coding - 2 years (Required)
Certifications:

One of the following certifications are required: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist-Physician-based (CCS-P), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

Must obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment.

Keywords:

Risk Adjustment Coding & Documentation Specialist, Talroo-Allied Health, Medical Office

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