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Medicare Risk Adjustment Provider Educator Jobs

Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82K - $108K/yr

... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... provider education in both MA and ACA line of business. * Manage the implementation process ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... provider education in both MA and ACA line of business. * Manage the implementation process ...

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... provider education in both MA and ACA line of business. * Manage the implementation process ...

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82K - $108K/yr

... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ... provider education in both MA and ACA line of business. * Manage the implementation process ...

Strive Health

Risk Adjustment Coder

Denver, CO · Remote

$27.88 - $32.21/hr

... improvement, provider education, analyzing reports, and identifying process improvements ... Extensive knowledge of documentation and coding guidelines established by the Center for Medicare ...

Msmc

Certified Risk Adjustment Coder Senior

Campus, IL · On-site

$22 - $30/hr

Queries and provides feedback and education to physicians when identifying documentation ... Utilizes analytics, identifies and target IMED physicians for Medicare Risk Adjustment training and ...

Strive Health

Risk Adjustment Coder

Denver, CO · On-site

$19.25 - $25.75/hr

... improvement, provider education, analyzing reports, and identifying process improvements ... Extensive knowledge of documentation and coding guidelines established by the Center for Medicare ...

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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.
Sr. Manager Health Business Analytics, Medicare Risk Adjustment - Remote

Sr. Manager Health Business Analytics, Medicare Risk Adjustment - Remote

Guidewell

Remote

$119K - $194K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

Job Description
Job Summary:
Manages a team through providing oversight, strategy implementation and execution for Medicare Risk Adjustment Programs. This role plays a pivotal role in managing and optimizing Medicare Advantage (MA) risk adjustment programs. This position will lead the design, planning, measurement, predictive analytic modeling and facilitate an evidenced based approach to drive decisions that enable the growth objectives of the business by leveraging data to enhance revenue accuracy, improve provider documentation, and ensure regulatory compliance
Essential Functions:
  • The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Oversee the end-to-end strategy for risk adjustment programs, including prospective and retrospective processes. This involves managing provider workflows, chart reviews, and coding validation to ensure accurate documentation under CMS-HCC models.
  • Partner with actuarial and finance teams to support bid development, producing defensible risk score projections, trend analysis, and revenue assumptions. This includes communicating results to executive leadership.
  • Manage work to produce customer value by planning and forecasting, setting objectives and priorities, establishing goals, clarifying accountabilities, assigning work and utilizing management and financial controls.
  • Lead analysis, provide recommendations, and represent Analytics
  • Work closely with leaders across business areas to drive results across the business
  • Manage levels of performance and assist with employees' professional growth by planning and building an effective organization; communicating effectively; coordinating with others; maintaining employee morale; motivating, recognizing and rewarding others; coaching and developing others, and engaging in self-development.
  • Manage business and public relationships and situations to obtain better business outcomes; communicate effectively and coordinate with others.
  • Develop, prioritize and implement strategy; set policies and procedures and manage creativity and innovation with primary goal of impacting health business

Required Work Experience:
8+ years related work experience. Experience Details: Strong Risk Adjustment experience in commercial and or Medicare.
3+ years direct supervisory/management experience
Related Bachelor's degree or additional related equivalent work experience
Experience working with statistical methodologies and risk adjustment
Experience writing SQL /SAS or related code to perform quantitative risk score analysis
Advanced Excel skills
Experience using algorithms and inferential statistics.
Expert consulting, negotiating, communicating, consensus building, presentation and facilitation skills
In-depth business process knowledge of several key business functional areas
Expert-level ability communicating highly complex information clearly and articulately for all levels and audiences
Demonstrated leadership abilities including effective knowledge sharing and conflict resolution
Experience communicating and presenting detailed business and financial information
Ability to understand overall Analytics strategy and apply/implement the strategy in assigned projects/initiatives/programs
Preferred Qualifications:
Experience working within the healthcare insurance industry
Bachelor's degree in a related field Business Analytics, Health Economics or similar program
Master's degree in a related field
General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
What We Offer:
As a Florida Blue employee, you will be at the heart of GuideWell's vision - to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
  • Medical, dental, vision, life and global travel health insurance;
  • Income protection benefits: life insurance, short- and long-term disability programs;
  • Leave programs to support personal circumstances;
  • Retirement Savings Plan including employer match;
  • Paid time off, volunteer time off, 10 holidays and 2 well-being days;
  • Additional voluntary benefits available; and
  • A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range: $119,400 - $194,000
Typical Annualized Hiring Range: $119,400 - $149,200
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

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