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Medicare Risk Adjustment Jobs in Kentucky (NOW HIRING)

Humana

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medicare Risk Adjustment knowledge * Analyzing data to build unique education strategies in PowerBi Additional Information Work at home - with ability to travel (up to 35% to surrounding provider ...

Humana

$25.50 - $29/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medicare Risk Adjustment knowledge * Analyzing data to build unique education strategies in PowerBi Additional Information Work at home - with ability to travel (up to 35% to surrounding provider ...

Mercy

Physical Therapist

Lexington, KY · On-site

$1.4K - $1.8K/wk

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Minimize Patient Risk: Helps decrease re-hospitalizations by front loading visits for high risk ... Completes all clinical documentation following agency protocol and Medicare/Federal guidelines.

Alternate Solutions Health Network

Physical Therapist

Lexington, KY · On-site

$1.6K - $2.1K/wk

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Minimize Patient Risk: Helps decrease re-hospitalizations by front loading visits for high risk ... Completes all clinical documentation following agency protocol and Medicare/Federal guidelines.

Alternate Solutions Health Network

Physical Therapist

Lexington, KY

$1.6K - $2.1K/wk

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Minimize Patient Risk: Helps decrease re-hospitalizations by front loading visits for high risk ... Completes all clinical documentation following agency protocol and Medicare/Federal guidelines.

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Medicare Risk Adjustment information

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$11

$19

$34

How much do medicare risk adjustment jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for medicare risk adjustment in Kentucky is $19.47, according to ZipRecruiter salary data. Most workers in this role earn between $13.99 and $23.61 per hour, depending on experience, location, and employer.

What are jobs in Medicare Risk Adjustment?

Jobs in Medicare risk adjustment include work in data analytics, consulting, insurance, and closely related industries. Your duties and responsibilities differ depending on the type of work. For example, as a Medicare risk-adjustment consultant, you provide advice and recommendations to healthcare organizations or an insurance provider on how to mitigate risk across a customer pool. Data analytics and statistics specialists gather and analyze insurance and Medicare data and documentation from hospitals, healthcare providers, and other medical care facilities that accept Medicare. This includes reviewing different types of diagnosis and comparing patient chart information. Some health care providers have in-house risk adjustment workers, while others contract with outside consulting and analytics firms.

What is the difference between Medicare Risk Adjustment vs Medicare Coding Specialist?

AspectMedicare Risk AdjustmentMedicare Coding Specialist
Primary FocusAssessing patient health risk scores for reimbursementAccurately coding medical diagnoses and procedures
Required CredentialsCertifications in risk adjustment or coding, often CPC or RHITCertifications like CPC, CCS, or RHIT
Work EnvironmentHealth plans, risk adjustment companies, healthcare providersHospitals, clinics, billing departments
Industry UsageUsed for Medicare Advantage plan reimbursementsUsed for medical billing and claims processing

While both roles involve healthcare coding and require similar certifications, Medicare Risk Adjustment focuses on evaluating patient health data to determine reimbursement levels, whereas Medicare Coding Specialists concentrate on accurately coding diagnoses and procedures for billing purposes.

What is Medicare Risk Adjustment?

Medicare Risk Adjustment is a process used by the Centers for Medicare & Medicaid Services (CMS) to adjust payments to Medicare Advantage plans based on the health status and demographic characteristics of their enrolled beneficiaries. The goal is to ensure that plans receive appropriate compensation for taking care of members with varying levels of health risk. This system uses diagnosis codes and other data to predict future healthcare costs, encouraging plans to provide comprehensive care and accurately document patient conditions.

What are some common challenges faced by professionals working in Medicare Risk Adjustment roles?

Professionals in Medicare Risk Adjustment often encounter challenges such as staying current with frequently changing CMS regulations, ensuring the accurate capture and documentation of patient diagnoses, and collaborating effectively with providers to optimize risk scores. The role requires meticulous attention to detail when reviewing medical records and coding, as well as strong communication skills to educate and support healthcare teams. Additionally, there can be pressure to meet strict deadlines for data submission and to ensure compliance with audit standards.

What are the key skills and qualifications needed to thrive in Medicare Risk Adjustment?

To excel in Medicare Risk Adjustment, you need a solid understanding of medical coding (especially ICD-10), healthcare regulations, and risk adjustment methodologies, often supported by credentials like CRC or CPC certifications. Familiarity with data analytics platforms, EHR systems, and specialized risk adjustment software is typically required. Strong attention to detail, analytical thinking, and effective communication are crucial soft skills for interpreting complex clinical data and collaborating across teams. These competencies ensure accurate risk scores, compliance with CMS requirements, and optimal financial outcomes for healthcare organizations.
More about Medicare Risk Adjustment jobs
What are popular job titles related to Medicare Risk Adjustment jobs in Kentucky? For Medicare Risk Adjustment jobs in Kentucky, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment jobs in Kentucky look for? The top searched job categories for Medicare Risk Adjustment jobs in Kentucky are:
Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Kentucky as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, and 3% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $40,502 per year, or $19.5 per hour.

Senior Coding Educator

Humana

On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago

Humana rating

8.0

Company rating: 8.0 out of 10

Based on 265 frontline employees who took The Breakroom Quiz

163rd of 304 rated insurance

Job description

Become a part of our caring community
The Senior Coding Educator identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. You will report to the Manager, Coding Education

As the Senior Coding Educator you will be

  • Responsible for creating and executing the risk adjustment strategy for each provider groups.

  • Analyze data and reporting and provides educational sessions with providers aimed at quality of care, documentation and coding improvements.

  • Collaboration with relationship owners and HQRI

  • Monitor and develops strategy with Coding educator and leader, tailor's provider group webinars and discussions based on various MRA topics.

  • Creates compliant PowerPoint Presentations tailored to group strategy


Use your skills to make an impact

Required Qualifications

  • AAPC CPC (Certified Professional Coder) Certification

  • 2 or more years of medical record review knowledge

  • Familiar with coding guidelines (i.e. ICD-9/ICD-10)

  • Reside in AL, TN LA or MS

  • Analyzing Data to drive process improvement

  • Microsoft Word (creating documents) and Excel (formulas, pivot tables)

  • PowerPoint (creating and presenting)

  • Experience with public speaking /presentation skills

Preferred Qualifications

  • Bachelor's degree

  • Certified Risk Coder (CRC)

  • Experience interacting with healthcare providers

  • Medicare Risk Adjustment knowledge

  • Analyzing data to build unique education strategies in PowerBi

Additional Information

Work at home - with ability to travel (up to 35% to surrounding provider offices)

In person meetings, quarterly

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.

  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

#LI-BB1

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$71,100 - $97,800 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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About Humana

Sourced by ZipRecruiter

Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Louisville, KY, US

Year founded

1961

Social media

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