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Medicare Risk Adjustment Jobs in Michigan (NOW HIRING)

Kanak Elite Services Inc

Sr. Business Analyst

Grand Rapids, MI · On-site

$88K - $114K/yr

We're looking for a Risk Adjustment Business Analyst with strong expertise in CMS regulations, Medicare Advantage, and compliance-driven program execution. The ideal candidate will combine regulatory ...

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Medicare Risk Adjustment information

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How much do medicare risk adjustment jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for medicare risk adjustment in Michigan is $19.54, according to ZipRecruiter salary data. Most workers in this role earn between $14.04 and $23.65 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 the most commonly searched types of Medicare Risk Adjustment jobs in Michigan? The most popular types of Medicare Risk Adjustment jobs in Michigan are:
What are popular job titles related to Medicare Risk Adjustment jobs in Michigan? For Medicare Risk Adjustment jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment jobs in Michigan look for? The top searched job categories for Medicare Risk Adjustment jobs in Michigan are:
Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 12% Part Time, and 3% Contract. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution, with an average salary of $40,645 per year, or $19.5 per hour.

Sr. Business Analyst

Kanak Elite Services Inc

Grand Rapids, MI • On-site

$88K - $114K/yr

Contractor

Re-posted 22 days ago

Job description

Hello There,

My name is Himanshu Sharma, and I serve as the Recruitment Lead at Kanak-IT INC. I am reaching out to share an excellent career opportunity for the role of Sr. Business Analyst with our esteemed client. If you are interested then please share your updated resume at Himanshu01@kanakits.com .

Job Description

Position           : Sr. Business Analyst

Location          : Grand Rapids, MI Hybrid (1 time a week) LOCALS 

Duration         : 9+ Months


Engagement Description –
This engagement requires a highly skilled Risk Adjustment Business Analyst who can bridge regulatory requirements with operational execution across Medicare Advantage and other risk-bearing programs. The analyst will help ensure compliance with CMS guidelines, minimize operational risk, and contribute to the overall success of Risk Adjustment activities by the plan.
The ideal candidate will bring a strong foundation in risk adjustment), reviewing and translating regulatory requirements and helping the business area implement compliant and optimal solutions. Additionally, the Business Analyst will support industry level research to ensure that best practices are implemented that minimize risk, while maximizing health outcomes for the organization’s members. 
Success in this role demands cross-functional collaboration, critical thinking, and the ability to operate in a fast-paced, high-stakes environment. This engagement directly supports our organization’s ability to remain compliant, optimize RAF accuracy, and achieve sustainable reimbursement outcomes.

We're looking for a Risk Adjustment Business Analyst with strong expertise in CMS regulations, Medicare Advantage, and compliance-driven program execution. The ideal candidate will combine regulatory knowledge, data analysis, and process improvement skills to enhance risk adjustment accuracy, ensure compliance, and drive operational efficiency.
Top 3 Required Skills/Experience –

  • Business Requirements Gathering:
    • They research, interpret and understand CMS regulations and applicable laws pertaining to risk adjustment
    • They collaborate with stakeholders to gather and document business requirements for risk adjustment programs, translating them into functional specifications for business teams.
  • Risk Management
    • They develop and implement risk assessment and monitoring review processes to mitigate and/or remediate risk within the risk adjustment space.
    • They track and manage corrective action plans to address identified compliance risks and deficiencies
  • Process Improvement:
    • They analyze existing controls and processes against guidance to enhance and strengthen those processes and controls in alignment with current guidance and best practices.
    • They support the documentation, implementation and tracking of  controls and systems which create enhanced efficiency and effectiveness.

Required Skills/Experience – The rest of the required skills/experience.  Include:  

  • Technical Skills:
    • Data Analysis: Ability to analyze large datasets to identify trends, patterns, and anomalies related to risk adjustment and compliance. This includes:
      • Using data analysis tools and software.
      • Interpreting data to understand risk adjustment and compliance issues.
    • Business Intelligence (BI) and Reporting: Experience with BI tools and reporting platforms to create dashboards and reports for monitoring risk adjustment performance and compliance.
    • Proficiency in MS Office applications
  • Business Skills:
    • Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific compliance requirements.
    • Regulatory Compliance: Knowledge of healthcare regulations and laws, including HIPAA, and how they apply to risk adjustment data and processes.
    • Business Process Analysis: Ability to analyze existing business processes, identify inefficiencies, and recommend improvements to enhance compliance and performance.
    • Problem-solving: Ability to identify and assist with resolving complex compliance issues related to risk adjustment data and processes.
    • Communication: Excellent verbal and written communication skills to effectively communicate with internal teams, external partners, and regulatory bodies.
    • Attention to Detail: Meticulous attention to detail to ensure accuracy and compliance in data and processes.
    • Research: Ability to review conduct research and review of regulatory guidance to interpret and implement.
    • Project Management: Ability to manage projects related to risk adjustment initiatives and compliance projects, requiring skills like defining scope, identifying resources, and scheduling.
    • Stakeholder Management: Ability to collaborate effectively with various stakeholders, including clinical staff, IT teams, and management.
    • Critical Thinking and Decision-Making: Ability to analyze situations, make informed decisions, and develop solutions to complex problems.
    • Adaptability: Ability to adapt to changes in regulations and risk adjustment programs.

Preferred Skills/Experience – Optional but preferred skills/experience.  Include: 

  • Prior roles in a compliance and/or regulatory department

Education/Certifications – Include: 

  • Bachelor’s degree in healthcare administration, business, or a related field with strong quantitative and analytical coursework
  • Compliance related certification, e.g., CHC, CCP would be a plus, not required