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Medicare Risk Adjustment Coder Jobs (NOW HIRING)

Cano Health

Risk Adjustment Coder

Jupiter, FL

Job Summary The Risk Adjustment coder will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure ...

Cano Health

Risk Adjustment Coder

Jupiter, FL · On-site

Job Summary The Risk Adjustment coder will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure ...

Aquity Solutions

Director Risk Adjustment - Remote

$130K - $150K/yr

Director of Risk Adjustment About IKS Health For more information, visit: www.ikshealth.com IKS ... Expert-level understanding of the end-to-end CMS-HCC Medicare risk coding model, including ...

Genuine Health Group

MRA Coder

Miami, FL · On-site

$18 - $24/hr

Minimum 3 years of Medicare Risk Adjustment coding * Advanced Microsoft Excel * Familiar with HCC Dashboard tool * Strong knowledge of ICD-10 and CPT codes * Fluent in English and Spanish * Clean ...

Msmc

Certified Risk Adjustment Coder

Hialeah, FL

$20.50 - $27.75/hr

Demonstrates knowledge of coding and documentation standards as well as CMS risk adjustment guidelines and HCCs (hierarchical condition categories) * Reviews medical record to ensure all diagnosis ...

ClinDCast LLC

Risk Adjustment Coding Auditor

Albany, NY · Remote

$30 - $35/hr

... Certified Professional Coder) certification Active CRC (Certified Risk Adjustment Coder ... certification Proficiency in Microsoft Office Suite (Excel, Word, Outlook) This is a remote ...

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Medicare Risk Adjustment Coder information

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How much do medicare risk adjustment coder jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for medicare risk adjustment coder in the United States is $22.42, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $24.04 per hour, depending on experience, location, and employer.

What is a Medicare Risk Adjustment Coder?

A Medicare Risk Adjustment Coder is a healthcare professional responsible for reviewing medical records and assigning diagnostic codes to ensure accurate risk adjustment for Medicare Advantage plans. Their work helps determine the level of reimbursement health plans receive from Medicare based on the health status and risk profile of enrolled patients. Coders must have a strong understanding of ICD-10 coding, clinical documentation, and CMS regulations. They play a vital role in compliance and in ensuring that health plans receive appropriate funding for the care of their members.

What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Coder?

To thrive as a Medicare Risk Adjustment Coder, you need strong knowledge of ICD-10-CM coding guidelines, risk adjustment methodologies, and compliance standards, typically validated by a coding certification such as CPC or CRC. Familiarity with electronic health record (EHR) systems, coding software, and risk adjustment platforms is essential. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurate code assignment and collaboration with healthcare providers. These skills ensure precise risk score calculations, regulatory compliance, and optimal reimbursement for healthcare organizations.

What are some common challenges Medicare Risk Adjustment Coders face when ensuring accurate documentation for risk adjustment purposes?

Medicare Risk Adjustment Coders often encounter challenges such as incomplete or inconsistent provider documentation, which can make it difficult to capture all relevant diagnoses for accurate risk adjustment. They must stay current with ever-changing CMS guidelines and coding updates, requiring continual education and attention to detail. Additionally, collaboration with providers is essential to clarify documentation and ensure compliance, which can sometimes be challenging due to time constraints or varying levels of coding knowledge among clinicians.

What is the difference between Medicare Risk Adjustment Coder vs Medical Coder?

AspectMedicare Risk Adjustment CoderMedical Coder
CertificationsAHIMA or AAPC certifications, specialized in risk adjustmentAHIMA or AAPC certifications, general coding credentials
Work EnvironmentHealthcare organizations, insurance companies, risk adjustment teamsHospitals, clinics, physician offices
Industry UsageFocused on Medicare Advantage and risk adjustment programsBroad medical billing and coding across specialties

Medicare Risk Adjustment Coders specialize in coding for Medicare Advantage plans and risk adjustment models, requiring specific knowledge of CMS guidelines. Medical Coders have a broader scope, focusing on general medical billing and coding across various healthcare settings. While both roles require coding certifications, Medicare Risk Adjustment Coders focus on risk scores and Medicare-specific data, making their expertise more specialized.

How much do Medicare Risk Adjustment Coders make in the US?

Medicare Risk Adjustment Coders in the US typically earn between $50,000 and $75,000 annually, depending on experience, certification, and location. Experienced coders with certifications like CPC or CRC may earn higher salaries, especially in healthcare hubs or with specialized skills in coding and compliance.

How to become a Medicare Risk Adjustment Coder?

To become a Medicare Risk Adjustment Coder, individuals typically need a coding certification such as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), along with knowledge of medical coding and billing, especially related to Medicare and risk adjustment models. Gaining experience in medical coding, understanding healthcare regulations, and staying current with coding updates are also important steps in pursuing this role.
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What job categories do people searching Medicare Risk Adjustment Coder jobs look for?

The top searched job categories for Medicare Risk Adjustment Coder jobs are:

Medicare Risk Adjustment Coder jobs near you
Infographic showing various Medicare Risk Adjustment Coder job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, and 3% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $46,638 per year, or $22.4 per hour.

Manager, Risk Adjustment

Central Mass Health LLC

Worcester, MA • On-site

Full-time

Re-posted 7 days ago

Job description

Description:

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients’ needs in mind.


We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.


Essential Duties and Responsibilities:

Program Strategy & Execution

  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance

  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits — monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support

  • Build and maintain the RA analytics layer — dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership

  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed.

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.


Requirements:
  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired.
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).