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Medicare Risk Adjustment Chart Review Jobs in Ladera Ranch, CA

Astiva Health

Manager of Quality Improvement

Orange, CA · On-site

$95K - $130K/yr

... Medicare and HMO services. We focus on providing thorough care that's specially designed for the ... risk adjustment factors (RAF). * Conducts comprehensive, concurrent, and retrospective reviews ...

Astiva Health

Manager of Quality Improvement

Orange, CA · On-site

$95K - $130K/yr

... Medicare and HMO services. We focus on providing thorough care that's specially designed for the ... risk adjustment factors (RAF). * Conducts comprehensive, concurrent, and retrospective reviews ...

Astiva Health

Jr. Quality Improvement Coder

Orange, CA · On-site

... Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of ... review of data to evaluate HEDIS and Risk Adjustment Factor. * Conduct internal reviews of ...

Astiva Health

Jr. Quality Improvement Coder

Orange, CA · On-site

$25 - $28/hr

... Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of ... review of data to evaluate HEDIS and Risk Adjustment Factor. * Conduct internal reviews of ...

Alignment Healthcare

VP, Internal Audit

Orange, CA

Drawing on deep expertise in Medicare Advantage risk adjustment, RADV compliance, and encounter data integrity, this role drives continuous improvement of internal controls, proactively surfaces ...

Alignment Healthcare

VP, Internal Audit

Orange, CA · On-site

Drawing on deep expertise in Medicare Advantage risk adjustment, RADV compliance, and encounter data integrity, this role drives continuous improvement of internal controls, proactively surfaces ...

Astiva Health

Software Engineer

Orange, CA · On-site

... Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of ... risk adjustment operations. Working closely with data analysts, clinical staff, and operational ...

Astiva Health

Software Engineer

Orange, CA · On-site

$70K - $85K/yr

... Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of ... risk adjustment operations. Working closely with data analysts, clinical staff, and operational ...

Worky

Software Engineer

Orange, CA · On-site

$120 - $150/hr

... Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of ... risk adjustment operations. Working closely with data analysts, clinical staff, and operational ...

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All JobsMedicare Risk Adjustment Chart Review JobsMedicare Risk Adjustment Chart Review Jobs in Ladera Ranch, CA

Medicare Risk Adjustment Chart Review information

See Ladera Ranch, CA salary details

$19

$46

$84

How much do medicare risk adjustment chart review jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for medicare risk adjustment chart review in Ladera Ranch, CA is $46.04, according to ZipRecruiter salary data. Most workers in this role earn between $33.46 and $56.49 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?

AspectMedicare Risk Adjustment Chart ReviewMedical Coder
Primary FocusReviewing patient charts to ensure accurate risk adjustment data for MedicareAssigning medical codes based on clinical documentation for billing and records
CertificationsOften requires coding certifications and knowledge of Medicare guidelinesCertified Professional Coder (CPC) or equivalent
Work EnvironmentHealthcare facilities, insurance companies, or remoteHospitals, clinics, or billing companies
Industry UsageMedicare Advantage plans, risk adjustment programsMedical 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 Ladera Ranch, CA are hiring for Medicare Risk Adjustment Chart Review jobs?

Cities near Ladera Ranch, CA with the most Medicare Risk Adjustment Chart Review job openings:

Medicare Risk Adjustment Chart Review jobs near you
Infographic showing various Medicare Risk Adjustment Chart Review job openings in Ladera Ranch, CA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $95,757 per year, or $46 per hour.

Risk Adjustment Coding Specialist II - Orange County

Orange, CA • Remote

Astrana Health, Inc.
See more jobs at Astrana Health, Inc.external

$70K - $85K/yr

Full-time

Re-posted 9 days ago

Job description

Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Orange County market.  In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You’ll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you’ll track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success. 
We are seeking candidates who have experience with risk adjustment experience, and we are open to training those without previous provider education experience! This position requires travel to provider offices up to 50% of the time OC.
Our Values: 
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
  • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) 
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines 
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
  • Other duties as assigned

Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification -  Certified Coding Specialist (CCS-P), CCS, or CPC.
  • At least 3 years of experience in risk adjustment coding and/or billing experience required
  • Reliable transportation/Valid Driver’s License/Must be able to travel up to 75% of work time
  • PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
  • Excellent presentation, verbal and written communication skills, and ability to collaborate 
  • Must possess the ability to educate and train provider office staff members
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.
You're great for this role if:    
  • Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
  • Certified Risk Adjustment Coder (CRC) and/or Risk Adjustment coding experience
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
  • Strong PowerPoint and public speaking experience
  • Ability to work independently and collaborate in a team setting
  • Experience with Monday.com
  • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

Environmental Job Requirements and Working Conditions
  • The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
  • This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. This position requires up to 75% travel to provider offices in Orange County. 
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.    

Additional Information:     
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.