Medical Coder CPC / CCS
$18 - $24.25/hr
Provide overall coding expertise as well as administrative and technical oversight to ensure successful integration of Molina Medicare's Risk Adjustment initiatives. May require some travel to ...
Medical Coder CPC / CCS
$18 - $24.25/hr
Provide overall coding expertise as well as administrative and technical oversight to ensure successful integration of Molina Medicare's Risk Adjustment initiatives. May require some travel to ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Chillicothe, OH. This unique opportunity adapts to ...
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Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Chillicothe, OH. This unique opportunity adapts to ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Oak Harbor, OH. This unique opportunity adapts to your ...
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Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Oak Harbor, OH. This unique opportunity adapts to your ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Internal Medicine, Quality Advanced Practice Provider
Columbus, OH · Remote
$94K - $128K/yr
AbsoluteCare is a value-based care organization serving high-risk Medicaid and Medicare populations ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Internal Medicine, Quality Advanced Practice Provider
Columbus, OH · Remote
$94K - $128K/yr
AbsoluteCare is a value-based care organization serving high-risk Medicaid and Medicare populations ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Nurse Practitioner - Family Practice/Primary Care job available in Cleveland, Ohio
Cleveland, OH · Remote
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Nurse Practitioner - Family Practice/Primary Care job available in Cleveland, Ohio
Cleveland, OH · Remote
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Community Based Quality Advanced Practice Provider - 3001
Columbus, OH · On-site
$99K - $135K/yr
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Community Based Quality Advanced Practice Provider - 3001
Columbus, OH · On-site
$99K - $135K/yr
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
... Medicare populations across Ohio. We go BeyondMedicine to deliver whole-person care through ... The annual wellness visits are conducted for the purpose of risk adjustment and quality gap closure ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ...
New
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Cleveland, OH. This unique opportunity adapts to your ...
New
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ...
New
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waverly, OH. This unique opportunity adapts to your ...
New
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Mansfield, OH. This unique opportunity adapts to your ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Elyria, OH. This unique opportunity adapts to your ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Elyria, OH. This unique opportunity adapts to your ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical input into product design, Medicare bids, risk adjustment, STARS, HEDIS, value-based arrangements, and clinical integration initiatives. * Communicate complex clinical, regulatory ...
REMOTE - Vice President Medical Director of Clinical Programs
New Hampshire, OH · Remote
$286K - $353K/yr
Provide clinical input into product design, Medicare bids, risk adjustment, STARS, HEDIS, value-based arrangements, and clinical integration initiatives. * Communicate complex clinical, regulatory ...
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Medicare HCC Mode; or any combination of education and experience, which would provide an ...
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Medicare HCC Mode; or any combination of education and experience, which would provide an ...
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Medicare HCC Mode; or any combination of education and experience, which would provide an ...
Serves as the primary resource and subject matter expert on all CMS Risk Adjustment and quality ... Medicare HCC Mode; or any combination of education and experience, which would provide an ...
Billing Specialist
$19 - $26/hr
Familiarity with Medicare LCD/NCD guidance and state-specific Medicaid policies. * Knowledge of risk adjustment (HCC), HEDIS-quality documentation, and prior auth workflows.
Billing Specialist
$19 - $26/hr
Familiarity with Medicare LCD/NCD guidance and state-specific Medicaid policies. * Knowledge of risk adjustment (HCC), HEDIS-quality documentation, and prior auth workflows.
Billing Specialist
Columbus, OH · On-site
$19 - $26/hr
Familiarity with Medicare LCD/NCD guidance and state-specific Medicaid policies. * Knowledge of risk adjustment (HCC), HEDIS-quality documentation, and prior auth workflows.
Billing Specialist
Columbus, OH · On-site
$19 - $26/hr
Familiarity with Medicare LCD/NCD guidance and state-specific Medicaid policies. * Knowledge of risk adjustment (HCC), HEDIS-quality documentation, and prior auth workflows.
PCP Nurse Practitioner
Dayton, OH · On-site
Accurately document diagnoses with attention to proper coding practices, supporting risk adjustment ... state Medicare/Medicaid exclusion lists, criminal history, education verification, license ...
New
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PCP Nurse Practitioner
Dayton, OH · On-site
Accurately document diagnoses with attention to proper coding practices, supporting risk adjustment ... state Medicare/Medicaid exclusion lists, criminal history, education verification, license ...
New
This role leads Medicare, Medicaid, Tricare, and other governmental reimbursement programs ... Review cost report settlements, appeals, adjustments, and audit findings. Research, prepare, and ...
This role leads Medicare, Medicaid, Tricare, and other governmental reimbursement programs ... Review cost report settlements, appeals, adjustments, and audit findings. Research, prepare, and ...
Medicare Risk Adjustment information
See Ohio salary details
$12.11 - $14.48
16% of jobs
$15.09 is the 25th percentile. Wages below this are outliers.
$14.48 - $16.85
34% of jobs
$16.85 - $19.22
18% of jobs
$19.22 - $21.59
1% of jobs
$22.84 is the 75th percentile. Wages above this are outliers.
$21.59 - $23.95
10% of jobs
$23.95 - $26.32
4% of jobs
$26.32 - $28.69
3% of jobs
$28.69 - $31.06
2% of jobs
$31.06 - $33.43
9% of jobs
$33.43 - $35.80
0% of jobs
$35.80 - $38.16
2% of jobs
$12
$21
$38
How much do medicare risk adjustment jobs pay per hour?
As of Jul 31, 2026, the average hourly pay for medicare risk adjustment in Ohio is $21.31, according to ZipRecruiter salary data. Most workers in this role earn between $15.29 and $25.82 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 Ohio? The most popular types of Medicare Risk Adjustment jobs in Ohio are:
What are popular job titles related to Medicare Risk Adjustment jobs in Ohio? For Medicare Risk Adjustment jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment jobs in Ohio look for? The top searched job categories for Medicare Risk Adjustment jobs in Ohio are:
$18 - $24.25/hr
Other
Re-posted 11 days ago
Job description
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Company Job Description/Day to Day Duties:
Job Summary
Directly responsible and accountable for performing chart reviews, physician education, and development of tools to ensure that our provider partners are compliant with Risk Adjustment. Provide overall coding expertise as well as administrative and technical oversight to ensure successful integration of Molina Medicare's Risk Adjustment initiatives. May require some travel to various provider partner locations
Performs on-going chart reviews and abstracts diagnoses codes under the HCC Model.Â
Develop an understanding of current billing practices in provider offices to ensure that diagnoses codes are submitted accordingly.Â
Documents results/findings from chart reviews and provides feedback to management, providers, and office staff.Â
Responsible for administrative duties such as planning, scheduling of chart reviews, obtaining of medical records, and provider training and education.Â
Monitor HCC Coding Accuracy at various levels of detail (e.g., by state, by product, by demographic segmentations). Extract information necessary to identify where there are low performing physicians; follow up with plan for education and training. Continue to audit to ensure training is implemented.Â
Resolve and track escalated issues. Track any coding issues identified either at the provider level (including Molina sites) or vendor; manage any non-compliance situation or potential fraud or abuse.Â
Utilize discretion and autonomy to select provider for further training or audits; coordinate efforts with internal clients such as Coding Manager, RAMP Director, State Medicare Directors and Provider Services.Â
Determine coding quality as it relates to CMS standards; selects physicians or vendors that require an audit.Â
Qualifications
Minimum Education/Qualifications/Licensures:
Coding Certification - Active CCS, CCS-P, or CPC credentialing
Coding guidelines knowledge
Travel required (with mileage)
Claims experience
Additional Information
Employment Type: Contract 6 months. With possibility of going perm.
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003