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Medicare Risk Adjustment Program Specialist Jobs

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Oversee Medicare DSNP Risk Adjustment strategy and execution. * Directly support key operational initiatives to ensure program stability and scalability. Minimum Education and Experience ...

Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare ... Prefer one-year experience with risk adjustment program in a Health Plan or Provider setting (i.e ...

Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...

Risk Adjustment Specialist

Birmingham, AL · On-site

$92K/yr

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high ... Training and Development Programs to develop new skills and reach career goals * Employee ...

Communicates QA results to the Medical Coding Specialists with suggestions for improvement and re ... Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is ...

$60 - $80/hr

Communicate QA results to the Medical Coding Specialists with suggestions for improvement and re ... Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is ...

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Medicare Risk Adjustment Program Specialist information

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$12

$22

$40

How much do medicare risk adjustment program specialist jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for medicare risk adjustment program specialist in the United States is $22.42, according to ZipRecruiter salary data. Most workers in this role earn between $16.11 and $27.16 per hour, depending on experience, location, and employer.

What is a Medicare Risk Adjustment Program Specialist?

Medicare Risk Adjustment Program Specialists are professionals who oversee and manage the processes related to Medicare's risk adjustment programs. Their main responsibility is to ensure accurate documentation and coding of patient diagnoses, which impacts the reimbursement rates received by healthcare providers from Medicare Advantage plans. They analyze medical records, educate healthcare teams on coding requirements, and help identify areas for improvement in compliance and data accuracy. This role is crucial for maximizing revenue integrity and ensuring healthcare organizations meet regulatory standards.

What are some typical challenges faced by a Medicare Risk Adjustment Program Specialist, and how can they be addressed?

A Medicare Risk Adjustment Program Specialist often encounters challenges such as keeping up with frequent regulatory changes, ensuring accurate and timely data collection, and collaborating with clinicians to capture complete diagnostic information. Staying current with CMS guidelines and investing in ongoing training can help address these issues. Effective communication with healthcare providers and leveraging data analytics tools are also essential for maintaining compliance and optimizing risk scores.

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

To thrive as a Medicare Risk Adjustment Program Specialist, you need a solid understanding of medical coding, health care regulations, and data analysis, often supported by a degree in health information management or a related field. Familiarity with risk adjustment software, ICD-10 coding systems, and CMS guidelines is typically required, along with certifications such as CPC or CRC. Strong attention to detail, analytical thinking, and effective communication skills help ensure accurate data capture and collaboration across teams. These competencies are crucial for optimizing risk scores, ensuring compliance, and securing appropriate reimbursement for healthcare organizations.

What are popular job titles related to Medicare Risk Adjustment Program Specialist jobs?

For Medicare Risk Adjustment Program Specialist jobs, the most frequently searched job titles are:

Risk Adjustment Provider Educator

Indiana, PA • Remote

Millennium Physician Group
Health Care and Social Assistance • 1 - 5K employees

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago


Millennium Physician Group rating

6.3

Company rating: 6.3 out of 10

Based on 63 frontline employees who took The Breakroom Quiz

672nd of 898 rated healthcare providers


Job description

Job Description Summary

The Risk Adjustment Provider Educator provides Risk Adjustment education to providers and all support staff through a variety of mediums including direct interactive learning sessions individually or in group settings, written guides and protocols, audits, etc. This role will provide analytical interpretation of Risk Adjustment data to determine areas of focus and improvement opportunities. In addition, this role will facilitate and provide detailed analysis, reporting, training, education, and support to Providers and staff to promote accurate clinical documentation along with HCC opportunities identified via performed analysis.

How will you make an impact & Requirements

Position is a hybrid role; work is remote with some travel to physician offices in the region. We are looking for 3 Educators to cover 3 different regions:

  • Central Region: Beech Grove, Camby, Carmel, Columbus, Greenwood, Indianapolis, Mooresville, & Plainfield

  • West Region: Brook, Crawfordsville, Lafayette, Rensselaer, West Lafayette, & Wheatfield

  • North Region: Cedar Lake, Chesterton, Crown Point, Dyer, Hammond, LaPorte, Lowell, Michigan City, Munster, Schererville, St. John, Valparaiso, & Winfield

Responsibilities
Transforms raw data into actionable intelligence to prioritize provider education and risk adjustment initiatives.
Possesses a proven ability to analyze, report, and provide data insights.
Identifies documentation and coding improvement opportunities and gives guidance around best practice strategies in risk adjustment performance.
Analyzes provider coding patterns and performs follow-up audits post-education to track documentation and coding improvement.
Demonstrates knowledge and an ability to apply coding policies and guidelines to the provider documentation review process.
Possesses excellent attention to detail.
Stays current on applicable documentation guideline changes and rules.
Works effectively and efficiently within a team environment.
Adaptable to shifting priorities and demonstrates a willingness to do what it takes to meet team needs.
Understands and complies with policies and procedures for confidentiality of all patient records, HIPAA, and security of systems.
Promotes Millennium Physician Group's values.
Build relationships with the clinical and clerical teams to ensure open communication for questions concerning the Risk Adjustment program and its components
Demonstrate excellent guest service to internal team members and patients.
Perform other related duties as assigned.

Qualifications
Bachelor's Degree or equivalent work experience.
2+ years of experience in training program design and development
2+ years of experience in risk adjustment and ICD-10 coding in the Medicare Risk Adjustment
environment
Certified Risk Adjustment Coder (CRC) or similar.
Possess strong critical thinking and analytical skills and an extensive, in-depth knowledge of the HCC
Risk Adjustment models.
Proven ability to analyze data, present results effectively through provider education, and monitor the
effectiveness of the education provided.
Strong communication skills.
Intermediate Excel skills (Pivot tables, VLOOKUP, Advanced formulas, etc.) and data visualization skills.
Intermediate Microsoft PowerPoint skills with the ability to transform analytical output into simpleto-
understand visuals.
In-depth knowledge of ICD-10-CM diagnostic coding.
Must have excellent time management skills, be highly organized, self-motivated.
Excellent customer service, problem-solving skills, and attention to detail.
The ability to follow through timely on tasks is essential.
Possess excellent written, verbal, and interpersonal communication skills.
Must possess initiative; tact; poise; neat personal appearance; and physical condition commensurate
with the requirements of the position.
Project management of multiple initiatives with the ability to prioritize and meet deadlines.
Ability to work independently in a fast-paced, cross-functional environment.

Benefits:

  • 3 weeks PTO & 8 paid holidays

  • Medical, Dental, Vision

  • Employer Paid Basic Life & Short Term Disability coverage (goes into effect after 1 year of full-time employment)

  • 401(k) with match

  • Employee Wellness

  • Other Employee Discount programs like Tickets at Work and cell phone discounts

  • Other benefits: Dependent Care FSA, Voluntary Life, Long Term Disability, Critical Illness, Pet Insurance, and more

Why Millennium?

Millennium Physician Group is one of the largest comprehensive primary care practices with healthcare providers throughout Florida.

At Millennium Physician Group, you will find an organization that focuses on family and building a strong network of people to care for the communities we serve. We are always searching for employees who have a strong customer service attitude, fantastic teamwork skills and a willing smile ready to share.

Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual, and help you grow in your role with Millennium Physician Group.

If you are interested in joining an organization that puts an emphasis on team work and family, then Millennium Physician Group is the right choice.

Compensation Range:

$77,417.00

to

$116,126.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.


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