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Medicare Risk Adjustment Quality Manager Jobs (NOW HIRING)

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Formulate and manage the Risk Adjustment Department's operational budget. * Oversee Medicare DSNP Risk Adjustment strategy and execution. * Directly support key operational initiatives to ensure ...

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

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 ...

Centene

Risk Adjustment Auditor Educator

$56K - $101K/yr

Work in conjunction with other departments to include Provider Relations, Quality as well as the ... Medicare risk adjustment (HCC Coding) Required Other experience in teaching, training or an ...

Centene Corp.

$60 - $80/hr

... Managed Care Organization as a medical coder. * 2+ years of experience in coding with knowledge of Medicare risk adjustment (HCC Coding) required. * Other experience in teaching, training or an ...

Insight Global

Remote HCC Coder

Des Moines, IA · Remote

$19 - $22/hr

Review and code medical records in accordance with ICD and risk adjustment guidelines (2 charts per hour) * Meet established quality standards and productivity metrics Must Haves: -Medicare HCC ...

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Medicare Risk Adjustment Quality Manager information

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$91K

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How much do medicare risk adjustment quality manager jobs pay per year?

As of Sep 9, 2026, the average yearly pay for medicare risk adjustment quality manager in the United States is $91,047.00, according to ZipRecruiter salary data. Most workers in this role earn between $70,500.00 and $110,000.00 per year, depending on experience, location, and employer.

What does a Medicare Risk Adjustment Quality Manager do?

A Medicare Risk Adjustment Quality Manager oversees programs that ensure healthcare organizations accurately document and report patient diagnoses for Medicare Advantage plans. They analyze data, implement quality improvement initiatives, and ensure compliance with federal regulations related to risk adjustment coding and reporting. Their role involves working with clinical and administrative teams to optimize risk scores, improve documentation standards, and support audits. By doing so, they help organizations receive appropriate reimbursement and deliver high-quality care to Medicare beneficiaries.

What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Quality Manager?

To thrive as a Medicare Risk Adjustment Quality Manager, you need expertise in healthcare data analysis, risk adjustment methodologies, and a strong understanding of CMS regulations, usually supported by a degree in health administration, nursing, or a related field. Familiarity with risk adjustment software, EHR systems, and certifications like CRC (Certified Risk Adjustment Coder) are commonly required. Exceptional attention to detail, leadership, and effective communication skills help ensure quality initiatives and compliance across teams. These abilities are crucial for optimizing reimbursement accuracy, maintaining regulatory compliance, and driving quality improvements in Medicare Advantage programs.

What are some common challenges faced by Medicare Risk Adjustment Quality Managers in ensuring accurate data collection and reporting?

Medicare Risk Adjustment Quality Managers frequently encounter challenges such as ensuring the completeness and accuracy of clinical documentation, keeping up with evolving CMS guidelines, and coordinating effectively across multidisciplinary teams like coding, compliance, and clinical staff. They must also manage large volumes of data while maintaining confidentiality and data integrity. Balancing these responsibilities requires strong attention to detail, robust organizational skills, and proactive communication to minimize errors and optimize risk adjustment outcomes.

What is the difference between Medicare Risk Adjustment Quality Manager vs Medicare Data Analyst?

AspectMedicare Risk Adjustment Quality ManagerMedicare Data Analyst
Primary FocusEnsuring compliance and quality in risk adjustment processesAnalyzing Medicare data to identify trends and support decision-making
Required CredentialsCertifications in healthcare quality or risk adjustment, often a background in healthcare or codingStrong data analysis skills, proficiency in SQL, Excel, and data visualization tools
Work EnvironmentHealthcare organizations, insurance companies, risk adjustment departmentsData teams within healthcare or insurance companies, analytics departments

The Medicare Risk Adjustment Quality Manager primarily focuses on maintaining compliance and improving quality in risk adjustment processes, while the Medicare Data Analyst concentrates on analyzing Medicare data to support strategic decisions. Both roles require healthcare or data analysis credentials and are integral to Medicare-related organizations.

What are popular job titles related to Medicare Risk Adjustment Quality Manager jobs?

For Medicare Risk Adjustment Quality Manager jobs, the most frequently searched job titles are:

HEALTH CODER - HCC & RISK ADJUSTMENT

Burlingame, CA • Remote

NORTH EAST MEDICAL SERVICES
Health Care and Social Assistance • 51 - 200 employees
Learn more about NORTH EAST MEDICAL SERVICESexternal

$42.79 - $48.75/hr

Full-time

Re-posted 25 days ago

Job description

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization’s quality outcomes and financial performance.

ESSENTIAL JOB FUNCTIONS:

  • HCC Coding and Risk Adjustment (RA) Program Support
    • Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
    • Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
    • Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
  • Provider Training and Clinical Documentation Improvement (CDI)
  • Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
  • Provide one-on-one and group training to providers and clinical staff to improve documentation quality and accuracy.
  • Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.
  • Data Analysis and Reporting
    • Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
    • Generate reports and dashboards to track coding performance and documentation accuracy.
    • Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.
  • Compliance and Continuous Improvement
    • Stay up to date with changes in coding, risk adjustment, and Medicare regulations.
    • Assist in the development and implementation of internal coding policies and procedures.
    • Participate in quality improvement initiatives related to coding and documentation.
    • Performs other job duties as required by manager/supervisor
  • Education & Certification:
    • BS/BA Degree in Health Science or General Education is required. 
    • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification is required.
    • Additional CDI or auditing certifications (CCDS, CDEO, CPMA) are preferred.
  • Experience:
    • Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
    • Experience in provider education, clinical documentation improvement (CDI), and chart audits.
    • Previous experience working in an IPA, managed care organization, or similar setting is strongly preferred.
  • Skills & Competencies:
    • Excellent communication, presentation, and interpersonal skills.
    • Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
    • Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
    • Proficiency in electronic health records (EHR) and coding software.
    • Strong analytical and problem-solving skills.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluency in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This a full-time position. 

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