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Medicare Risk Adjustment Chart Review Jobs (NOW HIRING)

Bcbsri

Risk Adjustment Medical Coder

Providence, RI · On-site +1

$65K - $98K/yr

Perform medical record reviews of Medicare Advantage members to ensure proper medical diagnoses are ... Evaluate physician documentation and chart coding to retrieve all primary and secondary diagnosis ...

Pathways Health Partners

HCC Risk Coder

Leesburg, FL · On-site

$16.75 - $22.25/hr

... chart reviews while providing education and facilitating chart retrieval for Health Plan audits and ... training in Medicare Risk Adjustment (MRA), HCC coding documentation guidelines, rules, and ...

Pathways Health Partners

HCC Risk Coder

Leesburg, FL · On-site +1

$16.75 - $22.25/hr

... chart reviews while providing education and facilitating chart retrieval for Health Plan audits and ... training in Medicare Risk Adjustment (MRA), HCC coding documentation guidelines, rules, and ...

CINQCARE

Sr. Director, Risk Adjustment (0778)

Washington, DC · Remote

$146K - $183K/yr

... Medicare Advantage, Medicaid Managed Care, and ACO REACH programs. The Sr. Director will lead a ... and prospective chart review programs; manage vendor relationships and performance against ...

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

As of Jul 1, 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 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 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 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 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.
More about Medicare Risk Adjustment Chart Review jobs
What cities are hiring for Medicare Risk Adjustment Chart Review jobs? Cities with the most Medicare Risk Adjustment Chart Review job openings:
What states have the most Medicare Risk Adjustment Chart Review jobs? States with the most job openings for Medicare Risk Adjustment Chart Review jobs include:
What job categories do people searching Medicare Risk Adjustment Chart Review jobs look for? The top searched job categories for Medicare Risk Adjustment Chart Review jobs are:
Medicare Risk Adjustment Chart Review jobs near you
Infographic showing various Medicare Risk Adjustment Chart Review job openings in the United States as of June 2026, with employment types broken down into 1% Internship, 46% Full Time, 49% Part Time, and 4% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $90,079 per year, or $43.3 per hour.
Certified Coder (Risk Adjustment Experience Required) - REMOTE

Certified Coder (Risk Adjustment Experience Required) - REMOTE

Molina Healthcare

Long Beach, CA • Remote

$24.50 - $33.50/hr

Full-time

Posted 3 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

143rd of 277 rated insurance

Job description

JOB DESCRIPTION Job SummaryProvides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Performs on-going member medical chart reviews. Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials.
Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately.
Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff.
Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment.
Builds positive relationships between providers and the business by providing coding assistance as needed.
Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education.
Assists in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors.
Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks and participating in professional societies related to medical coding in the managed care industry.
Required Qualifications At least 2 years medical coding experience, or equivalent combination of relevant education and experience.
Certified Professional Coder (CPC).
Certified Coding Specialist (CCS).
Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge.
Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Ability to effectively interface with staff, clinicians, and management.
Excellent verbal and written communication skills.
Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Risk Adjustment Coder (CRC).
Certified Professional Payer - Payer (CPC-P).
Certified Coding Specialist - Physician Based (CCS-P).
Familiar with HCC (Hierarchical Condition Categories) Risk Adjustment Model.
Background in supporting risk adjustment management activities and clinical informatics.
Experience with risk adjustment data validation.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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