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Medicare Risk Adjustment Chart Review Jobs (NOW HIRING)

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 ...

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 ...

CINQCARE

Sr. Analyst, Risk Adjustment (0779)

Washington, DC · Remote

$81K - $101K/yr

... Medicare Advantage, Medicaid Managed Care, and ACO REACH programs. The Sr. Analyst serves as a key ... Perform retrospective and prospective data analysis to assess the impact of chart review programs ...

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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 Jun 9, 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:
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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 May 2026, with employment types broken down into 2% Locum Tenens, 15% As Needed, 60% Full Time, 18% Part Time, and 5% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $90,079 per year, or $43.3 per hour.
Risk Adjustment Director

Risk Adjustment Director

Central California Alliance for Health

Merced, CA • On-site, Remote

Other

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission ofaccessible, quality health care guided by local innovationleadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

We have an opportunity to join the Alliance as the Risk Adjustment Director leading the Risk Adjustment Department.

This position can be located in one of our service counties (Mariposa, Merced, Monterey, Santa Cruz, or San Benito) or remotely in California with expected travel to Alliance service area(s) once a quarter. Must reside in California upon hire.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Chief Financial Officer, you will:

  • Provide strategic management oversight in designing, implementing, directing, and monitoring the Alliance's Risk Adjustment Department functions
  • Direct the Risk Adjustment Department, act as a subject matter expert, and provide executive-level advice and guidance on coding and risk adjustment methodologies and overall business operations
  • Direct, manage, and supervise Risk Adjustment Department staff
ABOUT THE TEAM

The Finance Division acts as the guardian of the Alliance's financial health. We track the pulse of the organization by analyzing budgets, forecasting future performance, and navigating the ever-changing economic and political landscape. To keep the Alliance financially strong and secure, we wear several hats and partner with every department in the organization to translate fiscal data into insights and action. From managing funds to risk management and compliance, we ensure the Alliance's responsible use of public funds.

This role will lead Medicare DSNP Risk Adjustment strategy and execution, overseeing a high-performing team of three. Current DSNP membership is approximately 800, with projected growth to 2,000 by year-end. While this is a leadership position, the current stage of the program requires a hands-on approach. The Director will be responsible for both guiding the strategic direction and directly supporting key operational initiatives to ensure program stability and scalability. This leader will work closely with cross-functional stakeholders to drive alignment, educate on program priorities, and advance key initiatives. Success in this role will require strong collaboration and influence to accelerate progress and embed risk adjustment best practices across the organization.

As the DSNP program evolves, this role will play a pivotal leadership role in scaling capabilities across physician engagement, cross-functional program coordination, and operational infrastructure. The scope and complexity of responsibilities will grow in alignment with membership expansion and organizational priorities.

THE IDEAL CANDIDATE
  • A motivated and seasoned leader in the managed care industry, with expertise in risk adjustments
  • Excellent communication skills, with strength in building relationships and partnering with cross-functional teams.
  • Champion accountability across the organization
  • Experience in overseeing the Medicare Risk Adjustment life cycle
  • Strong data and analytical skills, including SQL, dashboarding, and reporting
  • Be invested in staff development and empowering teams to do their best work
  • Medi-Cal experience is a plus
  • IPA/Medical Group experience highly desired
WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here.

  • Knowledge of:
    • The managed care industry and of Medicare health insurance payment methodologies
    • Medicare (Hierarchical Condition Categories) risk adjustment models
    • Methods and techniques of developing and delivering data management strategies that support contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations
    • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
    • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types
    • Methods and techniques of valuating for physician and inpatient and outpatient hospital costs
  • Ability to:
    • Demonstrate strong analytical skills, accurately collect, manage, and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
    • Perform complex analysis related to rate negotiations, health care cost reports, and determination of rates for hospitals, clinics, long-term care facilities, allied health services, professional services, and specialist services
    • Develop, plan, organize, and direct finance programs and activities that are complex in nature and regional in scope
    • Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues
    • Demonstrate a collaborative management style, build rapport, demonstrate excellent public relations skills, and effectively manage internal and external business relationships
  • Education and Experience:
    • Bachelor's degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a closely related field
    • A minimum of ten years of experience in healthcare finance or analytics, which included a minimum of five years of experience with Medicare risk adjustment processes, a minimum of two years of experience related to Medicare Managed Care Programs, and a minimum of three years of supervisory experience (a Master's degree may substitute for two years of general healthcare finance or analytics experience); or an equivalent combination of education and experience may be qualifying
OTHER INFORMATION
  • We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
  • While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
  • In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

COMPENSATION INFORMATION

  • Zone 1 Pay Range: $210,000 - $250,000
    Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  • Zone 2 Pay Range: $200,000 - $235,000
    Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it's not one of the typical areas listed. You can reach out tocareers@thealliance.health, and a member from our Talent Acquisition team will be in touch.

The hiring ranges represent a goodfaith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 12 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • Onsite EV Charging Stations
ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at ourFact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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