To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial ... Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial ... Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial ... Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial ... Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial ... Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial ... Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
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 ...
Quick apply
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 ...
Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or ...
Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or ...
Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or ...
Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or ...
Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or ...
Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or ...
Field Nurse Practitioner / Physician Assistant - St. Clair County, Michigan
Port Huron, MI · On-site
$100/hr
About the Role Advantmed is seeking a licensed, dependable Nurse Practitioner (NP) or Physician Assistant (PA) to conduct structured, in-home wellness and risk adjustment assessments for Medicare ...
Field Nurse Practitioner / Physician Assistant - St. Clair County, Michigan
Port Huron, MI · On-site
$100/hr
About the Role Advantmed is seeking a licensed, dependable Nurse Practitioner (NP) or Physician Assistant (PA) to conduct structured, in-home wellness and risk adjustment assessments for Medicare ...
Field Nurse Practitioner / Physician Assistant - St. Clair County, Michigan
Port Huron, MI · On-site
$100/hr
About the Role Advantmed is seeking a licensed, dependable Nurse Practitioner (NP) or Physician Assistant (PA) to conduct structured, in-home wellness and risk adjustment assessments for Medicare ...
Field Nurse Practitioner / Physician Assistant - St. Clair County, Michigan
Port Huron, MI · On-site
$100/hr
About the Role Advantmed is seeking a licensed, dependable Nurse Practitioner (NP) or Physician Assistant (PA) to conduct structured, in-home wellness and risk adjustment assessments for Medicare ...
Field Nurse Practitioner / Physician Assistant - St. Clair County, Michigan
Port Huron, MI · On-site
$100/hr
About the Role Advantmed is seeking a licensed, dependable Nurse Practitioner (NP) or Physician Assistant (PA) to conduct structured, in-home wellness and risk adjustment assessments for Medicare ...
Quick apply
Field Nurse Practitioner / Physician Assistant - St. Clair County, Michigan
Port Huron, MI · On-site
$100/hr
About the Role Advantmed is seeking a licensed, dependable Nurse Practitioner (NP) or Physician Assistant (PA) to conduct structured, in-home wellness and risk adjustment assessments for Medicare ...
Develops and presents PHO/PO reports related to risk adjustment, quality including HEDIS/Medicare 5 Star performance, financial and utilization metrics. Analyzes data and makes recommendations to ...
Develops and presents PHO/PO reports related to risk adjustment, quality including HEDIS/Medicare 5 Star performance, financial and utilization metrics. Analyzes data and makes recommendations to ...
Develops and presents PHO/PO reports related to risk adjustment, quality including HEDIS/Medicare 5 Star performance, financial and utilization metrics. Analyzes data and makes recommendations to ...
Develops and presents PHO/PO reports related to risk adjustment, quality including HEDIS/Medicare 5 Star performance, financial and utilization metrics. Analyzes data and makes recommendations to ...
EverCare Nurse Practitioner
Kalamazoo, MI · On-site
Understanding of value-based care, accountable care organizations (ACOs), Medicare care management and wellness programs (CCM, TCM, AWV), quality measures, risk adjustment, and population health ...
EverCare Nurse Practitioner
Kalamazoo, MI · On-site
Understanding of value-based care, accountable care organizations (ACOs), Medicare care management and wellness programs (CCM, TCM, AWV), quality measures, risk adjustment, and population health ...
... Medicare care management and wellness programs (CCM, TCM, AWV), quality measures, risk adjustment, and population health principles preferred; willingness to develop proficiency required. • Highly ...
... Medicare care management and wellness programs (CCM, TCM, AWV), quality measures, risk adjustment, and population health principles preferred; willingness to develop proficiency required. • Highly ...
EverCare Nurse Practitioner
Kalamazoo, MI · On-site
... Medicare care management and wellness programs (CCM, TCM, AWV), quality measures, risk adjustment, and population health principles preferred; willingness to develop proficiency required. • Highly ...
EverCare Nurse Practitioner
Kalamazoo, MI · On-site
... Medicare care management and wellness programs (CCM, TCM, AWV), quality measures, risk adjustment, and population health principles preferred; willingness to develop proficiency required. • Highly ...
EverCare Registered Nurse
Kalamazoo, MI · On-site
... quality reporting, risk adjustment data integrity, and compliant billing of care management ... Medicare care management billing requirements and HIPAA. • Adheres to the EverCare standards to ...
EverCare Registered Nurse
Kalamazoo, MI · On-site
... quality reporting, risk adjustment data integrity, and compliant billing of care management ... Medicare care management billing requirements and HIPAA. • Adheres to the EverCare standards to ...
EverCare Registered Nurse
Kalamazoo, MI · On-site
... quality reporting, risk adjustment data integrity, and compliant billing of care management ... Medicare care management billing requirements and HIPAA. • Adheres to the EverCare standards to ...
EverCare Registered Nurse
Kalamazoo, MI · On-site
... quality reporting, risk adjustment data integrity, and compliant billing of care management ... Medicare care management billing requirements and HIPAA. • Adheres to the EverCare standards to ...
... quality reporting, risk adjustment data integrity, and compliant billing of care management ... Medicare care management billing requirements and HIPAA. • Adheres to the EverCare standards to ...
... quality reporting, risk adjustment data integrity, and compliant billing of care management ... Medicare care management billing requirements and HIPAA. • Adheres to the EverCare standards to ...
Manage payer negotiations and contract performance for Medicare, Medicaid, and commercial payers ... Strong knowledge of healthcare contracting, risk adjustment methodologies, and payer-provider ...
Quick apply
Manage payer negotiations and contract performance for Medicare, Medicaid, and commercial payers ... Strong knowledge of healthcare contracting, risk adjustment methodologies, and payer-provider ...
Patient Health Coordinator
Troy, MI · On-site
$16.75 - $21.75/hr
... whether adjustments to the care plan are necessary. The PHC works collaboratively with the ... The PHC would advocate to the integrated care team during High-Risk Huddle and give their ...
Patient Health Coordinator
Troy, MI · On-site
$16.75 - $21.75/hr
... whether adjustments to the care plan are necessary. The PHC works collaboratively with the ... The PHC would advocate to the integrated care team during High-Risk Huddle and give their ...
Medicare Risk Adjustment information
See Michigan salary details
$11.10 - $13.28
16% of jobs
$13.84 is the 25th percentile. Wages below this are outliers.
$13.28 - $15.45
34% of jobs
$15.45 - $17.62
18% of jobs
$17.62 - $19.79
1% of jobs
$20.94 is the 75th percentile. Wages above this are outliers.
$19.79 - $21.96
10% of jobs
$21.96 - $24.13
4% of jobs
$24.13 - $26.30
3% of jobs
$26.30 - $28.47
2% of jobs
$28.47 - $30.65
9% of jobs
$30.65 - $32.82
0% of jobs
$32.82 - $34.99
2% of jobs
$11
$19
$34
How much do medicare risk adjustment jobs pay per hour?
As of Jul 18, 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?
| Aspect | Medicare Risk Adjustment | Medicare Coding Specialist |
|---|---|---|
| Primary Focus | Assessing patient health risk scores for reimbursement | Accurately coding medical diagnoses and procedures |
| Required Credentials | Certifications in risk adjustment or coding, often CPC or RHIT | Certifications like CPC, CCS, or RHIT |
| Work Environment | Health plans, risk adjustment companies, healthcare providers | Hospitals, clinics, billing departments |
| Industry Usage | Used for Medicare Advantage plan reimbursements | Used 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, and why are they important?
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:
Revenue Management & Risk Adjustment Analyst III - Health Alliance Plan
Troy, MI • On-site
Full-time
Posted 26 days ago
Henry Ford Health rating
7.0
Based on 552 frontline employees who took The Breakroom Quiz
416th of 886 rated healthcare providers
Job description
General Summary:
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial Reporting and Analysis responsibilities for the oversight of the Revenue Management and/or Risk Adjustment programs for all government funded product lines. Under direction of Department Manager:
Principal Duties and Responsibilities:
Education/Experience Required:
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial Reporting and Analysis responsibilities for the oversight of the Revenue Management and/or Risk Adjustment programs for all government funded product lines. Under direction of Department Manager:
Principal Duties and Responsibilities:
- Coordination of weekly and ad hoc data submissions, monitoring data for accurate tracking and reporting of medical, drug claim data and membership data to CMS EDPS and Edge Server. Produce, distribute, monthly, quarterly, and annual key performance indicators (KPI's) and error/rejection detail for all report submissions and external vendor support system data correction.
- Premium reconciliation reports for monthly financial close; file payment issues with CMS and monitor response; monitor MMR, MOR, MAO-002, and MAO-004 loads; estimate risk adjustment premium impact for final reconciliation with CMS; allocation of premium to at-risk.
- Develop and enhance reporting capabilities for financial and operational performance.
- Annual financial reporting activities including CMS bid filings, HCR Premium Development, RFP on financial Risk Adjustment projects, Employer Group Rate Renewals, financial audits, CMS Attestations, premium and member revenue budgets, Medical Loss Ratio reporting.
- Produce reports to provide M&B discrepancies in the premium payments from CMS. Team with Membership & Billing staff to identify and resolve enrollment, claims, provider and premium discrepancies. Develop detail to support reporting discrepancies to CMS for discrepancies outside of M&B's influence.
- Monitor CMS material and calls for required compliance and system or process changes. Work with management on design and implementation of the changes.
- Development and maintenance of departmental policies and procedures for audit purposes and support department in adhering to HAP Compliance department requirements. Complete routine monitoring of departmental procedures and documentation to demonstrate internal (MAR) and external (CMS) audit readiness.
- Coordinate and assign tasks related to testing IT projects and new system related initiatives and CMS software releases.
- Analyze department reports to identify data integrity issues, system and programming problems, and work with management to develop and implement improvement solutions.
- Assist department in performing routine assignments, ad-hoc projects and meeting established deadlines. Engage assistance of departmental support analysts in completion of required responsibilities where appropriate.
- Perform other related duties as assigned.
Education/Experience Required:
- Bachelor's degree in Accounting, Finance, Business Administration or a related field (must include financial or accounting related course work). Master's degree preferred (Finance, Business Administration, etc.)
- Completion of Advanced Access, Excel, GQL, Cognos, or SQL training preferred.
- Two (2) years of Accounting/Finance business related experience required.
- Two (2) years managing projects and initiatives designed to improve business operations required.
- Three (3) to Five (5) years of experience developing, analyzing, interpreting & trending data preferred.
- Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
- Experience in health care finance preferred.
- Affordable Care Act (ACA) experience or knowledge preferred.
- Knowledge of Alteryx One preferred.
- Proficient knowledge of Windows - Excel and/or Access.
- Proficient at using various data sources to develop relevant reporting tools, and to use those tools to enhance processes and procedures.
- Knowledge of accounting and financial reporting principles and business functions.
- Ability to research, analyze, interpret, trend, and implement process improvement initiatives.
- Ability to collect and prepare data for written/oral presentation - report creation and generation.
- The ability to work effectively with all levels within the organization.
- Excellent written and verbal communication skills.
- Well defined problem solving and decision-making skills.
- Knowledge of Facets or other Health Insurance Claims/Membership systems preferred.
- Knowledge of Medicare and/or Medicare Advantage processes preferred
- Experience with Cognos, SQL Developer, GQL reporting tool, CDW, Data Factory. preferred.
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About Henry Ford Health
Sourced by ZipRecruiter
Henry Ford Health provides a full continuum of services from Primary and Preventative care, to Complex and Cpecialty care, Health Insurance, a full suite of home health offerings, Virtual care, Pharmacy, Eye care and other Healthcare retail. It is one of the Nation’s leading Academic Medical Centers, recognized for Clinical excellence in Cancer care, Cardiology and Cardiovascular Surgery, Neurology and Neurosurgery, Orthopedics and Sports medicine, and Multi organ transplants. Consistently ranked among the top five NIH funded institutions in Michigan, Henry Ford Health engages in more than 2,000 research projects annually. Equally committed to educating the next generation of Health Professionals, Henry Ford Health trains more than 4,000 Medical students, Residents and fellows every year across 50+ accredited programs. With more than 33,000 valued team members, Henry Ford Health is also among Michigan’s largest and most Diverse employers, including nearly 6,000 physicians and researchers from the Henry Ford Medical Group, Henry Ford Physician Network and Jackson Health Network.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Detroit, MI, US
Year founded
1915