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Medicare Risk Adjustment Provider Educator Jobs

Point32health

Risk Adjustment Consultant

Canton, MA · On-site

Work collaboratively with risk adjustment provider educators and the quality assurance team to focus the provider training and education specifically related to coding accuracy and documentation to ...

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Medicare Risk Adjustment Provider Educator information

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How much do medicare risk adjustment provider educator jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for medicare risk adjustment provider educator in the United States is $43.95, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $52.40 per hour, depending on experience, location, and employer.

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

To thrive as a Medicare Risk Adjustment Provider Educator, you need in-depth knowledge of risk adjustment coding, Medicare guidelines, and clinical documentation, usually supported by a relevant healthcare degree and certifications like CPC, CRC, or CCS-P. Familiarity with coding software, EMR systems, and data analytics tools is essential for analyzing records and providing effective education. Strong communication, presentation, and relationship-building skills distinguish top performers in this role. These abilities ensure accurate coding, regulatory compliance, and improved provider understanding, which are critical for optimizing reimbursement and reducing audit risk.

What are Medicare Risk Adjustment Provider Educators?

Medicare Risk Adjustment Provider Educators are professionals who train healthcare providers on accurately documenting and coding patient diagnoses for Medicare risk adjustment purposes. Their main goal is to ensure that providers understand the importance of thorough and precise medical record documentation, which directly impacts Medicare payments and compliance. They often lead educational sessions, review documentation practices, and provide ongoing support to help providers meet regulatory standards. By doing so, they help healthcare organizations receive appropriate reimbursement and improve patient care quality.

How does a Medicare Risk Adjustment Provider Educator typically collaborate with healthcare providers and coding teams?

A Medicare Risk Adjustment Provider Educator works closely with healthcare providers and coding teams to ensure accurate documentation and coding of diagnoses for risk adjustment purposes. They often conduct training sessions, provide feedback on documentation practices, and clarify coding guidelines to both individual clinicians and group practices. Regular collaboration may involve joint chart reviews, educational workshops, and ongoing communication to address documentation gaps or regulatory updates. This role requires strong interpersonal skills and an ability to translate complex regulatory information into practical guidance for busy clinical teams.

What is the difference between Medicare Risk Adjustment Provider Educator vs Medicare Risk Adjustment Analyst?

AspectMedicare Risk Adjustment Provider EducatorMedicare Risk Adjustment Analyst
CredentialsTypically requires healthcare certifications, training in risk adjustment, and teaching experienceRequires healthcare or data analysis certifications, proficiency in data tools, and risk modeling knowledge
Work EnvironmentEducational settings, provider offices, or training programsData analysis departments, healthcare organizations, or insurance companies
Employer & Industry UsageHospitals, health plans, and training organizationsInsurance companies, healthcare analytics firms, and health plans

The Medicare Risk Adjustment Provider Educator focuses on training healthcare providers on risk adjustment processes, while the Medicare Risk Adjustment Analyst analyzes data to optimize risk scores. Both roles require healthcare knowledge but differ in their primary functions and work environments.

Infographic showing various Medicare Risk Adjustment Provider Educator job openings in the United States as of June 2026, with employment types broken down into 13% Locum Tenens, 62% Full Time, 13% Part Time, 6% Temporary, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $91,418 per year, or $44 per hour.

Vice President, Medicare Stars and Risk Adjustment

Blue Cross and Blue Shield of Massachusetts, Inc.

Hingham, MA • On-site

$276K - $338K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted yesterday

Job description

Ready to help us transform healthcare? Bring your true colors to blue. 

Job Title: Vice President, Stars & Risk Adjustment Performance

Reports to:Senior Vice President, Government Programs

Position Overview

The Vice President of Stars & Risk Adjustment Performance is a strategic and analytical senior leader responsible for directing and monitoring all Stars and Risk Adjustment initiatives to achieve optimal outcomes. This role involves developing a unified strategy to drive efficiency and effectiveness across both programs, leveraging data and analytics to improve performance, and maximizing provider engagement to support financial goals.

The Vice President will collaborate with key stakeholders to communicate program results and advocate for Medicare business interests in cross-functional projects. This critical leadership position will influence a wide range of partners-including clinical, quality, analytics, member experience, and provider relations teams-to ensure the long-term success of the Medicare Advantage business. The ideal candidate is a natural leader with exceptional communication skills and a persuasive, thoughtful approach.

Direct Reports

This position will oversee a subject matter expert team for Stars program management and a full Risk Adjustment team, including management, data analysts, and risk coders.

Key Responsibilities

  • Develop and execute a multi-year business plan for Stars and Risk Adjustment, analyzing the interrelationships of product, operations, and program performance.
  • Establish, track, and drive performance targets and Key Performance Indicators (KPIs) for both Stars and Risk Adjustment programs.
  • Lead provider network engagement strategies to improve performance in Stars and Risk Adjustment.
  • Maintain expert knowledge of CMS regulations, industry trends, and best practices in Medicare Stars and Risk Adjustment.
  • Lead regular meetings with cross-functional teams, including Pharmacy, HEDIS, CAHPS, HOS, Operations, Provider Network and Analytics, as part of the operational model that includes a hierarchy of steering meetings and domain Stars work groups and specific workgroups with synergies for both Stars and Risk Adjustment Accuracy.
  • Analyze and communicate the business implications of federal legislative changes, market dynamics, and competitive threats, providing recommendations for action.

Qualifications

Required Experience & Skills:

  • A minimum of 15 years of leadership experience in Medicare Advantage Stars and/or Risk Adjustment.
  • Expert knowledge of Medicare Advantage Stars, Risk Adjustment, Provider Contracting, Product Development, Operations, Finance, and Analytics.
  • In-depth understanding of the Medicare Part D program, including operations, practices, and industry trends.
  • Demonstrated strength in analysis, problem identification, and resolution.
  • Proficiency with Medicare data and system interfaces.
  • Proven ability to collaborate with corporate planning leaders to execute a strategic plan.
  • Strong financial and analytical skills.
  • Excellent written, verbal, and interpersonal communication skills.
  • Ability to lead and manage deliverables through others in a highly matrixed environment.
  • Demonstrated ability to take ownership of problems and independently develop solutions.
  • High degree of professionalism with the ability to interact effectively with all levels of the organization and external parties.
  • Highly organized and capable of managing multiple projects simultaneously.

Education:

  • Bachelor's Degree required.
Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

LocationBoston, Dorchester, Hingham, Quincy, WorcesterTime TypeFull timeSalary Range: $276,930.00 - $338,470.00

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.

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