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Medicare Risk Adjustment Quality Manager Jobs (NOW HIRING)

Insight Global

Remote HCC medical coder

Philadelphia, PA · Remote

$20 - $23/hr

Perform accurate HCC risk adjustment coding for Medicare populations * Review and code medical records in accordance with ICD and risk adjustment guidelines * Meet established quality standards and ...

Insight Global

REMOTE HCC Coder

Denver, CO · Remote

$18 - $25/hr

Perform accurate HCC risk adjustment coding for Medicare populations * Review and code medical records in accordance with ICD and risk adjustment guidelines * Meet established quality standards and ...

Insight Global

Remote HCC Medical Coder

Texas City, TX · Remote

$20 - $23/hr

Medicare HCC experience is required * ICD 10 experience * 2 years' experience as a risk adjustment ... Collaborate with quality review teams and incorporate feedback as needed to ensure coding ...

Insight Global

Hcc Coders

Charlotte, NC · Remote

$18 - $21/hr

Perform accurate HCC risk adjustment coding for Medicare populations * Review and code medical records in accordance with ICD and risk adjustment guidelines * Meet established quality standards and ...

Cano Health

Auditor, ACO Coding

Miami, FL · On-site

$26 - $29.75/hr

... Medicare Risk Adjustment. You implement ongoing quality improvement activities to assure the ... Engage with practice management team members on applying correct steps into daily process including ...

Cano Health

Auditor, ACO Coding

Miami, FL

$26 - $29.75/hr

... Medicare Risk Adjustment. You implement ongoing quality improvement activities to assure the ... Engage with practice management team members on applying correct steps into daily process including ...

Astrana Health, Inc.

$160K - $170K/yr

Partner with business units like Risk Adjustment and Quality to identify analytical opportunities ... Experience in Medicare Risk Adjustment analytics, HCC/RAF gap analysis, encounter data, or revenue ...

VIVA Health

Risk Adjustment Specialist

Birmingham, AL

$92K/yr

... Medicare & Medicaid Services (CMS). Other responsibilities include working suspect reports to ... This position will assist the Manager of Risk Adjustment with other projects as needed. Why VIVA ...

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Medicare Risk Adjustment Quality Manager information

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$91K

$138.5K

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:

PBO Risk Adjustment Coding - BHC - FT - Finance/Accounting - Days

Fort Lauderdale, FL • On-site

Broward Health
Hospitals • 5 - 10K employees
Learn more about Broward Healthexternal

Full-time

Re-posted 20 days ago

Broward Health rating

6.9

Company rating: 6.9 out of 10

Based on 91 frontline employees who took The Breakroom Quiz

452nd of 898 rated healthcare providers

Job description

Broward Health Corporate ISC
Shift: Shift 1
FTE: 1.000000
Requisition: 31881
Summary: Ensures procedures , E&M and diagnoses are coded as documented in the medical records according to ICD-10-CM, CPT-4, and HCPCS, in an effort to maintain accurate coding and obtain reimbursement, all within the professional coding guidelines, Centers for Medicare and Medicaid (CMS) guidelines and Broward Health policies. Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness Visits, Medicare Risk HRA/HCC Assessment forms, Medicare Advantage plans suspect HCC condition forms prior to submission to the payer.
Education: High School or Equivalent
Experience: 2-5 years of risk adjustment coding, E/M, procedures and diagnosis experience required
Credentials: Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC). Proficient in Microsoft Word, Excel and PowerPoint. Competent in Electronic Health Records, NextGen and Cerner experience preferred.
Visit us online at www.BrowardHealth.org or contact Talent Acquisition
*Bonus Exclusions may apply in accordance with policy HR-004-026
Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race, color, national origin, gender, gender identity or gender expression, pregnancy, sexual orientation, religion, age, disability, military status, genetic information or any other characteristic protected under applicable federal or state law.
At Broward Health, the dedication and contributions of veterans are valued. Supporting the military community and giving back to those who served is a priority. Broward Health is proud to offer veteran's preference in the hiring process to eligible veterans and other individuals as defined by applicable law.

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About Broward Health

Sourced by ZipRecruiter

A career with Broward Health means endless opportunities to grow through a wide range of experiences across the healthcare system. You will be part of a team that is continually raising the bar for patient care. Our competitive benefits package includes healthcare coverage, a matching retirement program, pension plan, and wellness programs.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Fort Lauderdale, FL, US

Year founded

1938

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