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Medicare Risk Adjustment Coder Jobs (NOW HIRING)

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 ...

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Medicare Risk Adjustment Coder information

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$22

$34

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

As of Jun 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 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.

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

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 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 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.
More about Medicare Risk Adjustment Coder jobs
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 June 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $46,638 per year, or $22.4 per hour.

Risk Adjustment Specialist

LSMA Management Inc

San Bernardino, CA • On-site

$30 - $34/hr

Full-time

Posted 9 days ago

Job description

Job Type
Full-time
Description
JOB SUMMARY
The Risk Adjustment Specialist - Coding Compliance supports the organization's delegated Risk Adjustment and Coding Compliance programs by performing specialized audit support, documentation review coordination, coding validation support, medical record analysis, and compliance activities to promote accurate and complete Hierarchical Condition Category (HCC) capture in accordance with Centers for Medicare & Medicaid Services (CMS), California Department of Managed Health Care (DMHC), National Committee for Quality Assurance (NCQA), Office of Inspector General (OIG), and contracted health plan requirements.
This role supports coding compliance oversight activities related to Medicare Advantage Risk Adjustment, Risk Adjustment Data Validation (RADV), provider documentation integrity, and coding accuracy initiatives. The position assists with identifying documentation gaps, monitoring coding compliance trends, coordinating audit preparation activities, and supporting provider education efforts to ensure accurate Risk Adjustment Factor (RAF) scoring and regulatory compliance.
The Risk Adjustment Specialist collaborates closely with Coding Compliance leadership, certified coders, providers, population health teams, utilization management, care management, quality improvement, and health plans to support compliant documentation and coding practices, audit readiness, and delegated risk adjustment program performance.
Requirements
MINIMUM & PREFERRED QUALIFICATIONS:
Education/Training
Minimum: High school diploma or GED equivalent required
Preferred: Associate's degree or higher in healthcare administration, public health, social services, or related field.
Experience
Minimum: At least one year of experience in one or more of the following areas: risk adjustment, coding compliance, medical record review, managed care, healthcare administration, managed care or MSO environment, medical office or provider operations.
Preferred: Experience supporting Medicare Advantage Risk Adjustment programs. Experience supporting CMS RADV audits or coding compliance audits. Experience in an MSO, IPA, health plan, delegated entity, or managed care environment. Experience working with electronic health records, coding software, or Risk Adjustment platforms.
Certification(s)
Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or other coding certification preferred.
Skills, Knowledge & Abilities
  • Knowledge of CMS Risk Adjustment methodology, HCC documentation requirements, and RAF score principles.
  • Understanding of Medicare Advantage Risk Adjustment, coding compliance, and documentation integrity requirements.
  • Familiarity with CMS RADV audit standards, DMHC regulatory requirements, NCQA standards, and delegated health plan oversight requirements.
  • Ability to identify documentation deficiencies, coding inconsistencies, compliance risks, and audit-related concerns.
  • Strong organizational, analytical, auditing, and data tracking skills with exceptional attention to detail and accuracy.
  • Ability to maintain accurate records, audit logs, compliance documentation, and reporting tools.
  • Proficiency with electronic health records, Risk Adjustment platforms, coding software, and Microsoft Office applications.
  • Strong verbal and written communication skills with the ability to communicate professionally with providers, coders, leadership, health plans, and interdisciplinary teams.
  • Ability to handle confidential and sensitive information in compliance with HIPAA and organizational policies.
  • Ability to manage multiple priorities, deadlines, and audit-related activities in a fast-paced managed care environment.
  • Ability to work independently while collaborating effectively within interdisciplinary operational and compliance teams.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:
The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Primarily sedentary work involving prolonged computer use. Occasional standing, walking, and local travel may be required. Ability to lift up to 20 pounds occasionally. Requires strong attention to detail, data analysis capability, and effective communication skills. Work is performed in an office or remote environment supporting electronic medical record and Risk Adjustment systems.
PAY RANGE
$30.00 - $34.00 / hourly
Salary Description
$30.00 - $34.00 / hourly

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