... review * Certified Risk Adjustment Coder (CRC) with compliance experience * Provider coding audit/compliance leadership experience * Medicare Advantage compliance leadership experience supporting ...
... review * Certified Risk Adjustment Coder (CRC) with compliance experience * Provider coding audit/compliance leadership experience * Medicare Advantage compliance leadership experience supporting ...
Auditor, Risk Adjustment
Dallas, TX · Remote
$82K - $108K/yr
... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in ...
Auditor, Risk Adjustment
Dallas, TX · Remote
$82K - $108K/yr
... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in ...
Medical Director - Medicare Shared Savings Program - ACO
Dallas, TX · On-site
$250 - $360/hr
Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred ... Participate in quarterly performance reviews with CMS and provide leadership input for ACO ...
Medical Director - Medicare Shared Savings Program - ACO
Dallas, TX · On-site
$250 - $360/hr
Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred ... Participate in quarterly performance reviews with CMS and provide leadership input for ACO ...
Auditor, HCC Risk Adjustment Coding
Dallas, TX · Remote
$29 - $32/hr
As an HCC (Hierarchical Condition Category) Auditor you will review medical records that have been ... for risk adjustment and reimbursement purposes. You will play a critical role in translating ...
Auditor, HCC Risk Adjustment Coding
Dallas, TX · Remote
$29 - $32/hr
As an HCC (Hierarchical Condition Category) Auditor you will review medical records that have been ... for risk adjustment and reimbursement purposes. You will play a critical role in translating ...
Remote Certified Coder
Dallas, TX · Remote
$22.25 - $30.50/hr
Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ... Check chart assignments every day and report accurately all hours worked on a weekly basis. Report ...
Remote Certified Coder
Dallas, TX · Remote
$22.25 - $30.50/hr
Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ... Check chart assignments every day and report accurately all hours worked on a weekly basis. Report ...
Remote Certified Coder
Dallas, TX · On-site +1
$22.25 - $30.50/hr
Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ... by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM ...
Remote Certified Coder
Dallas, TX · On-site +1
$22.25 - $30.50/hr
Altegra Health specializes in: 1. CMS HCC Risk Adjustment 2. HEDIS 3. Medical Record Reviews ... by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred ... Participate in quarterly performance reviews with CMS and provide leadership input for ACO ...
Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred ... Participate in quarterly performance reviews with CMS and provide leadership input for ACO ...
Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred ... Participate in quarterly performance reviews with CMS and provide leadership input for ACO ...
Experience with CMS MSSP quality reporting, risk adjustment, and performance improvement preferred ... Participate in quarterly performance reviews with CMS and provide leadership input for ACO ...
Primary Care Physician
Dallas, TX · On-site
Review and address quality metrics, including HEDIS and STAR measures, to optimize clinical ... Strong understanding of HEDIS, STAR ratings, risk adjustment, and preventative care measures
Quick apply
Primary Care Physician
Dallas, TX · On-site
Review and address quality metrics, including HEDIS and STAR measures, to optimize clinical ... Strong understanding of HEDIS, STAR ratings, risk adjustment, and preventative care measures
Clinical Risk Manager
Dallas, TX · On-site
Clinical Chart Reviews: Perform regular chart audits and reviews of Nurse Practitioner consults to identify potential risk vulnerabilities or systemic process gaps. * Data-Driven Insights: Analyze ...
Quick apply
Clinical Risk Manager
Dallas, TX · On-site
Clinical Chart Reviews: Perform regular chart audits and reviews of Nurse Practitioner consults to identify potential risk vulnerabilities or systemic process gaps. * Data-Driven Insights: Analyze ...
Bilingual Nurse Practitioner, Clinical Educator
Mesquite, TX · On-site
$93K - $127K/yr
... Medicare-eligible Hispanic seniors. Celebrate diversity and inclusivity in a workplace that ... Perform additional duties related to clinical education, documentation support, chart review, and ...
Bilingual Nurse Practitioner, Clinical Educator
Mesquite, TX · On-site
$93K - $127K/yr
... Medicare-eligible Hispanic seniors. Celebrate diversity and inclusivity in a workplace that ... Perform additional duties related to clinical education, documentation support, chart review, and ...
... risk Medicare Advantage, and REACH.In this role, you will guide teams, empower providers, and shape ... risk adjustment, quality outcomes, and medical expense management while nurturing critical ...
Quick apply
... risk Medicare Advantage, and REACH.In this role, you will guide teams, empower providers, and shape ... risk adjustment, quality outcomes, and medical expense management while nurturing critical ...
Senior Vice President, Value Based Care
Plano, TX · On-site
$180 - $280/hr
... risk Medicare Advantage, and REACH. In this role, you will guide teams, empower providers, and ... Establish KPIs and performance standards that drive quality, risk adjustment accuracy ...
Senior Vice President, Value Based Care
Plano, TX · On-site
$180 - $280/hr
... risk Medicare Advantage, and REACH. In this role, you will guide teams, empower providers, and ... Establish KPIs and performance standards that drive quality, risk adjustment accuracy ...
... risk Medicare Advantage, and REACH. In this role, you will guide teams, empower providers, and ... Establish KPIs and performance standards that drive quality, risk adjustment accuracy ...
... risk Medicare Advantage, and REACH. In this role, you will guide teams, empower providers, and ... Establish KPIs and performance standards that drive quality, risk adjustment accuracy ...
... risk Medicare Advantage, and REACH. In this role, you will guide teams, empower providers, and ... Establish KPIs and performance standards that drive quality, risk adjustment accuracy ...
... risk Medicare Advantage, and REACH. In this role, you will guide teams, empower providers, and ... Establish KPIs and performance standards that drive quality, risk adjustment accuracy ...
Quality CDI Analyst, RN
Dallas, TX · Remote
Strength in risk identification and appropriate escalation * Able to deal with frequent change or unexpected events * Experience with criteriabased chart review, such as Case Management, Utilization ...
Quality CDI Analyst, RN
Dallas, TX · Remote
Strength in risk identification and appropriate escalation * Able to deal with frequent change or unexpected events * Experience with criteriabased chart review, such as Case Management, Utilization ...
Solution Architect with AI and Healthcare
Plano, TX · Remote
$60.25 - $79.50/hr
... claims operations, risk adjustment, Stars, quality, provider network optimization, and ... human-in-the-loop review, bias assessment, auditability, privacy, and regulatory compliance.
Solution Architect with AI and Healthcare
Plano, TX · Remote
$60.25 - $79.50/hr
... claims operations, risk adjustment, Stars, quality, provider network optimization, and ... human-in-the-loop review, bias assessment, auditability, privacy, and regulatory compliance.
AI Solutions Architect for Healthcare Payer and Life Science
Plano, TX · On-site
$119.58 - $221.62/hr
... claims operations, risk adjustment, Stars, quality, provider network optimization, and ... human-in-the-loop review, bias assessment, auditability, privacy, and regulatory compliance.
AI Solutions Architect for Healthcare Payer and Life Science
Plano, TX · On-site
$119.58 - $221.62/hr
... claims operations, risk adjustment, Stars, quality, provider network optimization, and ... human-in-the-loop review, bias assessment, auditability, privacy, and regulatory compliance.
Solution Architect with AI and Healthcare
Plano, TX · On-site
$60.25 - $79.50/hr
... claims operations, risk adjustment, Stars, quality, provider network optimization, and ... human-in-the-loop review, bias assessment, auditability, privacy, and regulatory compliance.
Solution Architect with AI and Healthcare
Plano, TX · On-site
$60.25 - $79.50/hr
... claims operations, risk adjustment, Stars, quality, provider network optimization, and ... human-in-the-loop review, bias assessment, auditability, privacy, and regulatory compliance.
Medicare Risk Adjustment Chart Review information
See Addison, TX salary details
$17.92 - $23.29
2% of jobs
$23.29 - $28.67
14% of jobs
$30.46 is the 25th percentile. Wages below this are outliers.
$28.67 - $34.04
28% of jobs
The median wage is $36.34 / hr.
$34.04 - $39.41
15% of jobs
$39.41 - $44.79
6% of jobs
$49.67 is the 75th percentile. Wages above this are outliers.
$44.79 - $50.16
11% of jobs
$50.16 - $55.53
11% of jobs
$55.53 - $60.91
8% of jobs
$60.91 - $66.28
4% of jobs
$66.28 - $71.65
0% of jobs
$71.65 - $77.03
0% of jobs
$17
$41
$77
How much do medicare risk adjustment chart review jobs pay per hour?
As of Aug 28, 2026, the average hourly pay for medicare risk adjustment chart review in Addison, TX is $41.92, according to ZipRecruiter salary data. Most workers in this role earn between $30.48 and $51.44 per hour, depending on experience, location, and employer.
What is Medicare Risk Adjustment Chart Review?
Medicare Risk Adjustment Chart Review is a process where healthcare professionals review patient medical records to identify and validate diagnoses that impact Medicare Advantage risk scores. This ensures that Medicare Advantage plans receive accurate reimbursement based on the health status and complexity of their enrollees. The review helps to capture any conditions that may not have been coded during patient visits, improving data accuracy and compliance with CMS regulations.
What are some common challenges faced in a Medicare Risk Adjustment Chart Review role, and how can they be managed?
A common challenge in Medicare Risk Adjustment Chart Review is ensuring the accuracy and completeness of medical documentation to support proper coding and risk adjustment. Reviewers often encounter incomplete records or ambiguous provider notes, which requires strong attention to detail and effective communication with healthcare staff to clarify information. Staying current with CMS guidelines and coding updates is essential, as regulations and requirements can change frequently. Proactively collaborating with providers and participating in regular training sessions can help manage these challenges and improve review quality.
What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Chart Reviewer, and why are they important?
To thrive as a Medicare Risk Adjustment Chart Reviewer, you need a solid understanding of medical coding (CPT, ICD-10), healthcare compliance, and clinical documentation, often supported by a coding certification such as CPC, CRC, or CCS. Familiarity with electronic medical records (EMRs), risk adjustment software, and auditing tools is typically required. Attention to detail, analytical thinking, and strong communication skills set top performers apart in accurately interpreting and reporting clinical data. These competencies are crucial for ensuring accurate risk adjustment, regulatory compliance, and optimized reimbursement for healthcare organizations.
What is the difference between Medicare Risk Adjustment Chart Review vs Medical Coder?
| Aspect | Medicare Risk Adjustment Chart Review | Medical Coder |
|---|---|---|
| Primary Focus | Reviewing patient charts to ensure accurate risk adjustment data for Medicare | Assigning medical codes based on clinical documentation for billing and records |
| Certifications | Often requires coding certifications and knowledge of Medicare guidelines | Certified Professional Coder (CPC) or equivalent |
| Work Environment | Healthcare facilities, insurance companies, or remote | Hospitals, clinics, or billing companies |
| Industry Usage | Medicare Advantage plans, risk adjustment programs | Medical billing, coding, and documentation |
While both roles involve medical documentation, Medicare Risk Adjustment Chart Review focuses on analyzing charts to optimize Medicare risk scores, whereas Medical Coders assign codes for billing purposes. Understanding these differences helps in choosing the right career path or job focus within healthcare documentation and billing.
What cities near Addison, TX are hiring for Medicare Risk Adjustment Chart Review jobs?
Cities near Addison, TX with the most Medicare Risk Adjustment Chart Review job openings:
Senior Manager, Corporate Compliance - Risk Adjustment
Irving, TX
CVS Health •
Health Care and Social Assistance • 10K+ employees10,000+ employees
5.8
Based on 4,352 frontline employees who took The Breakroom Quiz
90th of 113 rated pharmacies
Recommended by students
Recommended by parents
Respectful managers
Uninterrupted breaks
$75K - $165K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 6 days ago
Job description
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
Position Summary
As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk Adjustment, Hierarchical Condition Categories (HCCs), encounter data submission, documentation and coding compliance, and related regulatory requirements. This position serves as a key compliance leader and subject matter expert, partnering with Risk Adjustment Operations, Coding, Provider Education, Clinical Documentation Improvement (CDI), Internal Audit, Legal, and Government Affairs teams to ensure organizational adherence to CMS requirements.
The ideal candidate possesses extensive experience in Medicare Advantage compliance and a deep understanding of CMS Risk Adjustment methodologies, diagnosis coding requirements, medical record documentation standards, RADV audits, and evolving regulatory guidance.
Key Responsibilities
Lead the Medicare Advantage Risk Adjustment compliance program.
Monitor and interpret CMS regulations, HPMS memoranda, Final Rules, Medicare Managed Care Manual guidance, RADV requirements, and OIG enforcement activities.
Assess operational processes for compliance risks related to risk adjustment activities.
Develop and implement corrective action plans for identified compliance issues.
Conduct compliance risk assessments related to coding, documentation, and encounter data submissions.
Required Qualifications
Minimum 7 years of experience in Medicare Advantage, Risk Adjustment, Coding Compliance, Audit, or Regulatory Compliance
Minimum 5 years in a leadership role
One or more of the following certifications: CPMA (Certified Professional Medical Auditor), CRC (Certified Risk Adjustment Coder), CPC (Certified Professional Coder), CCS (Certified Coding Specialist)
Willingness to travel up to 10% (including by plane)
Preferred Qualifications
Health Information Management (RHIA/RHIT)
Nursing - Strong understanding of clinical documentation and medical record review
Certified Risk Adjustment Coder (CRC) with compliance experience
Provider coding audit/compliance leadership experience
Medicare Advantage compliance leadership experience supporting RADV, HCC validation, and CMS audits
Education
Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Compliance, or a related healthcare field required; equivalent years of work experience may substitue.
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
About CVS Health
Sourced by ZipRecruiter
Industry
Health care and social assistance and retail
Company size
10,000+ Employees
Headquarters location
Woonsocket, RI, US
Website
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Benefits
Hours and flexibility
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