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Medicare Risk Adjustment Coder Jobs (NOW HIRING)

Msmc

Certified Risk Adjustment Coder Senior

Miami Beach, FL

$22.25 - $30.25/hr

Utilizes analytics, identifies and target IMED physicians for Medicare Risk Adjustment training and documentation/coding resources. * Other duties as assigned. Qualifications * License/Registration ...

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 ...

Pathways Health Partners

HCC Risk Coder

Leesburg, FL · On-site

$16.75 - $22.25/hr

Administrative responsibilities, professional written and verbal communication, typing skills. 3. Documented training in Medicare Risk Adjustment (MRA), HCC coding documentation guidelines, rules ...

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

As of Jun 1, 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 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 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 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 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.

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 May 2026, with employment types broken down into 41% Full Time, and 59% Part Time. Highlights an 72% Physical, 24% Hybrid, and 4% Remote job distribution, with an average salary of $46,638 per year, or $22.4 per hour.

Certified Risk Adjustment Coder Senior

Msmc

Miami Beach, FL

$22.25 - $30.25/hr

Full-time

Medical, Life, Retirement, PTO

Posted 13 days ago

Job description

As Mount Sinai grows, so does our legacy in high-quality health care.

Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.

Culture of Caring: The Sinai Way

Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Department:

CC019053 Population Health Clinical Ops

Job Description Summary:

Position Responsibilities

  • Demonstrates knowledge of coding and documentation standards as well as CMS Risk Adjustment Program guidelines and HCCs (hierarchical condition categories).

  • Reviews medical record to ensure all diagnosis codes are documented for the assignment of a valid and accurate HCC for each episode of care.

  • Regularly reviews Epic HCC and payer reports.

  • Queries and provides feedback and education to physicians when identifying documentation deficiencies to improve accuracy of risk adjustment coding.

  • Demonstrates understanding of risk adjustment payment models.

  • Uses clinical reasoning and critical thinking skills to discern the financial impact of a query in order to prioritize efforts most efficiently.

  • Completes patient medical chart review upon visit completion by protocol, using the hospital resources (i.e. EPIC, Care Everywhere and Suspects reports provided by the Health plan).

  • Performs coding and abstracting with an accuracy rate higher than 95%.

  • Maintains log of activities as required for weekly and/or monthly reports (i.e. productivity and time management reports).

  • Provides the primary source of data and information used in health care.

  • Promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement.

  • Maintains effective interpersonal skills and positive working relationship with co-workers and physicians.

  • Promotes clear and accurate communications among the working team and with other related parties.

  • Maintains information organized and ready for easy and quick access.

  • Assists IMED physicians in understanding the CMS HCC Risk Adjustment Program as it relates to payment methodology and the importance of proper medical documentation of procedures and diagnosis coding.

  • Assists providers and other professional staff in retrieving and compiling data for research, diagnosis, and teaching purposes.

  • Utilizes analytics, identifies and target IMED physicians for Medicare Risk Adjustment training and documentation/coding resources.

  • Other duties as assigned.

Qualifications
  • License/Registration/Certification

    • CRC, CDEO, CPC, CPMA Certifications Required.

  • Education

    • High school graduate.

  • Experience

    • Five plus years' experience in Coding and Billing, Knowledge of ICD-10-CM and CPT.

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:

  • Health benefits
  • Life insurance
  • Long-term disability coverage
  • Healthcare spending accounts
  • Retirement plan
  • Paid time off
  • Pet Insurance
  • Tuition reimbursement
  • Employee assistance program
  • Wellness program
  • On-site housing for select positions and more!

Degree Requirements:

Certification:

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