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Medicare Risk Adjustment Chart Review Jobs (NOW HIRING)

Vertek Staffing

HCC Risk Adjustment Coder

Franklin, TN · Remote

$18 - $24/hr

This role supports Risk Adjustment initiatives through retrospective chart reviews, prospective ... Experience with Medicare Advantage populations * Experience with value-based care programs

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 ...

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Oversee Medicare DSNP Risk Adjustment strategy and execution. * Directly support key operational initiatives to ensure program stability and scalability. Minimum Education and Experience ...

Apex Health Solutions

Certified Medical Coder

Houston, TX · On-site

$21.50 - $29.25/hr

Minimum of three (3) years HCC experience performing concurrent and retrospective risk adjustment chart reviews required * Current AAPC or AHIMA credential required * Risk Adjustment / HCC knowledge ...

Apex Health Solutions

Certified Medical Coder

Houston, TX · On-site

$21.50 - $29.25/hr

Minimum of three (3) years HCC experience performing concurrent and retrospective risk adjustment chart reviews required * Current AAPC or AHIMA credential required * Risk Adjustment / HCC knowledge ...

Apex Health Solutions

Certified Medical Coder

Houston, TX

$21.50 - $29.25/hr

Minimum of three (3) years HCC experience performing concurrent and retrospective risk adjustment chart reviews required * Current AAPC or AHIMA credential required * Risk Adjustment / HCC knowledge ...

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Medicare Risk Adjustment Chart Review information

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$79

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

As of Aug 31, 2026, the average hourly pay for medicare risk adjustment chart review in the United States is $43.31, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $53.12 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.

More about Medicare Risk Adjustment Chart Review jobs

What cities are hiring for Medicare Risk Adjustment Chart Review jobs?

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What states have the most Medicare Risk Adjustment Chart Review jobs?

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What job categories do people searching Medicare Risk Adjustment Chart Review jobs look for?

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Medicare Risk Adjustment Chart Review jobs near you
Infographic showing various Medicare Risk Adjustment Chart Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $90,079 per year, or $43.3 per hour.

Risk Adjustment Coding Analyst Senior

Bloomington, MN • On-site

HealthPartners

7.5

Company rating: 7.5 out of 10

Based on 138 frontline employees who took The Breakroom Quiz

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$85 - $120/hr

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This job post has expired today. Applications are no longer accepted.

Job description

HealthPartners is hiring a Risk Adjustment Coding Analyst Senior.

This position is responsible for diagnosis coding review and vendor coding quality assurance; working to ensure that plan performance and plan revenue is based on an accurate representation of our population’s care needs and risks.

ACCOUNTABILITIES:
  1. Performs retrospective chart review for diagnosis coding accuracy.
  2. Identifies, analyzes, and reports coding error trends to inform risk adjustment analytics and deliver provider education.
  3. Reviews vendor coding and provide recurring feedback and education to vendor team.
  4. Participates in internal and CMS-mandated risk adjustment data validation review.
  5. Identifies, documents, and messages process improvements, clinical documentation improvements and/or other educational opportunities.
  6. Develops and performs training and educational seminars to physicians and advanced practice providers on risk adjustment topics.
  7. Increases collaborative efforts between HealthPartners Health Plan and HealthPartners Medical Group as it relates to optimization of diagnosis coding.
  8. Analyzes and organizes complex information for effective reporting to leadership.
  9. Conducts daily work consistent with HealthPartners core values and comply with all federal and state regulations.
  10. Maintains confidentiality of protected health information.
  11. Increases organizational efficiency in daily operations.
  12. Responsible for other duties as assigned.
REQUIRED QUALIFICATIONS:
  • High School Diploma or GED or Associate’s degree in a related field
  • One of the following credentials required: RHIA, RHIT, CPC, CCS, CCS-P
  • Certified Risk Adjustment Coder (CRC) credential
  • Minimum of five years experience with diagnosis coding review as a certified coder
  • Demonstrated working knowledge of the revenue cycle process, claims processing, retrospective chart review process, compliance and federal/state regulations, CPT, ICD-9, and ICD-10 coding
  • Identify issues and formulate solutions relating to retrospective chart review process improvement initiatives
  • Understand and communicate clinical documentation requirements for correct coding and to ensure integrity of the medical record
  • Skill and experience in effectively collaborating with team members & others using oral, written and interpersonal communications
  • PC skills in Microsoft Word and Excel
  • Organize and prioritize multiple assignments
  • Ability to deal with change and ambiguity
  • Able to work, both, as a team member or independently
PREFERRED QUALIFICATIONS:
  • Four year college degree
  • Experience working with Epic
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