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Medicare Risk Adjustment Jobs in New York (NOW HIRING)

MetroPlusHealth

Risk Adjustment Specialist

Manhattan, NY · Hybrid

$72K - $82K/yr

Position Overview Risk Adjustment is a growing and critical field within Health Insurance Finance ... Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines ...

MetroPlusHealth

Risk Adjustment Specialist

Manhattan, NY · On-site

$72K - $82K/yr

Position Overview Risk Adjustment is a growing and critical field within Health Insurance Finance ... Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines ...

Stanford Health Care

Sr Risk Adjustment Coder

Newark, NJ · On-site

$44.13 - $57.36/hr

The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare ...

ISHE

Executive Director of Risk Adjustment

Manhattan, NY · On-site

$135 - $231/hr

Lead enterprise risk adjustment strategy for Medicare Advantage, Medicaid, and Commercial risk contracts * Drive accurate and sustainable RAF performance through prospective and retrospective ...

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How much do medicare risk adjustment jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for medicare risk adjustment in New York is $24.53, according to ZipRecruiter salary data. Most workers in this role earn between $17.60 and $29.71 per hour, depending on experience, location, and employer.

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 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 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.

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 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.

More about Medicare Risk Adjustment jobs

What are the most commonly searched types of Medicare Risk Adjustment jobs in New York?

The most popular types of Medicare Risk Adjustment jobs in New York are:

What are popular job titles related to Medicare Risk Adjustment jobs in New York?

For Medicare Risk Adjustment jobs in New York, the most frequently searched job titles are:

What job categories do people searching Medicare Risk Adjustment jobs in New York look for?

The top searched job categories for Medicare Risk Adjustment jobs in New York are:

Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in New York as of August 2026, with employment types broken down into 67% Full Time, and 33% Contract. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $51,018 per year, or $24.5 per hour.

Risk Adjustment Specialist

MetroPlusHealth

Manhattan, NY • Hybrid

$72K - $82K/yr

Full-time

Posted 26 days ago

MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

274th of 315 rated insurance

Job description

Position Overview

Risk Adjustment is a growing and critical field within Health Insurance Finance. This is your opportunity

to support this function at MetroPlusHealth, New York City’s not-for-profit health insurance company. As a Risk Adjustment Specialist, you will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate information to federal and state agencies. You will work independently to monitor and support internal partners and external vendors in data collection and submission. You’ll apply your problem-solving skills to resolve issues you identify. You will also calculate errors and acceptance rates to track progress over time.

This opportunity is ideal for an individual interested in working at the intersection of Health Insurance Analytics and Operations, who excels at creative problem solving, is detail-oriented, and who is committed to our mission of providing access to health insurance to all New Yorkers.

Scope of Role and Responsabilities 

  • Ongoing monitoring of data submitted by vendors to ensure project goals are being met,
  • submitted data is complete and accurate, and errors are identified quickly.
  • Proactively work with external and internal partners to resolve issues – this includes identifying the root cause, devising plans to remediate, and ensuring on-time completion from all stakeholders.
  • Support end-to-end submission processes and encounter data across all lines of business, including Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines, resubmissions, and validating accepted and rejected encounter metrics to ensure data is accurately reflected in downstream reporting.
  • Perform financial impact analysis of Risk Adjustment activities, including implications of data errors, missed submissions, and remediation efforts.
  • Access and analyze data within the enterprise data warehouse to evaluate member, provider, claims, and enrollment data in support of Risk Adjustment and encounter data initiatives.
  • Utilize dashboards to identify trends and potential opportunities in data collection and reportng. 

Required Education, Training & Professional Experience

  • Bachelor’s degree required, with a demonstrated interest in Finance, Social Services or Health Care.
  • Minimum of 3-4 years’ experience required working for a Health Plan, or in a Finance, Project Management or Actuarial capacity in another industry.
  • Ability to work independently to investigate, pinpoint, and resolve problems.
  • Strong analytical and financial skills. Experience using SQL, R, SAS or another programming language is a plus.
  • Proactive communication style and ability to work with a variety of stakeholders to achieve project goals.

Professional Competencies 

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication

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