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Medicare Risk Adjustment Jobs in Ohio (NOW HIRING)

Humana Inc

Healthcare Market Finance Lead

Columbus, OH · On-site

$104 - $143/hr

Analyze market financials, claims data, utilization trends, membership movement, risk adjustment ... Experience in the Medicare Advantage bid process * 3 or more years of experience in Service Fund ...

New

Transtreme

Be Seen First

Nurse Practitioner - Home Visits - Full Time - Columbus

Columbus, OH · On-site

$130K - $145K/yr

... the Medicare health assessment landscape by delivering high-quality, patient-centered care through innovative risk adjustment models. Operating across multiple states and rapidly expanding ...

CareSource

Medical Economics Analyst II

Dayton, OH · On-site +1

$72K - $115K/yr

... risk adjustment dynamics, revenue impacts, utilization management, and identifying key drivers ... Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is required

New

Mercy

Occupational Therapist (OT)

Canton, OH · On-site

$35.25 - $46.50/hr

Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for ... Develop an individualized OT plan of care and make adjustments as needs change. * Evaluation:

Summa Health System

Physical Therapist PRN

Akron, OH · On-site

Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for ... Helps decrease re-hospitalizations by front loading visits for high risk patients * Treats patients ...

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All JobsMedicare Risk Adjustment JobsMedicare Risk Adjustment Jobs in Ohio

Medicare Risk Adjustment information

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$12

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$38

How much do medicare risk adjustment jobs pay per hour?

As of Aug 23, 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 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 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:

Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 91% Full Time, 6% Part Time, and 2% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $44,333 per year, or $21.3 per hour.

Billing Specialist

LOWER LIGHTS CHRISTIAN HEALTH CENTER INC

Columbus, OH • On-site

$19 - $26/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 25 days ago

Job description

ABOUT LLCHC
Lower Lights Christian Health Center (LLCHC) transforms the overall health of Central Ohio, serving one individual at a time. We are focused on whole-person wellness, available to ALL in Central Ohio who need it, regardless of ability to pay! In 2019 alone, we served over 12,000 patients - with 40% being uninsured - and totaled 50,000+ medical encounters!
Operating out of seven locations, we offer medical care (primary care, dental, vision, OB/GYN, telehealth), behavioral health care, 340B pharmacy, nutritional assistance programs, and more. Working hours are Monday - Friday with occasional Saturday morning coverage.
SUMMARY:
The Medical Billing Specialist ensures accurate coding, timely claim submission, and efficient reimbursement for clinical services. This role reviews documentation, assigns codes, prepares and submits claims, follows up on denials, and maintains compliance with payer policies and HIPAA.
ESSENTIAL JOB RESPONSIBILITIES:
  • Review clinical documentation and assign accurate ICD-10-CM, CPT, and HCPCS codes.
  • Prepare, scrub, and submit clean claims to commercial, Medicare/Medicaid.
  • Verify insurance eligibility/benefits and obtain prior authorizations as needed.
  • Monitor claims status; research, correct, and resubmit denials/edits; post payments and adjustments.
  • Manage patient billing: statements, payment plans, refunds, and resolution of billing inquiries.
  • Reconcile daily charges, payments, and balances; escalate discrepancies.
  • Maintain current knowledge of payer policies, NCCI edits, and regulatory updates.
  • Protect PHI and uphold HIPAA and organizational privacy/security policies.
  • Collaborate with providers, clinical staff, and revenue cycle team to optimize documentation and reimbursement.

Core Competencies
  • Accuracy & Compliance (coding guidelines, HIPAA)
  • Analytical Problem-Solving (EOB/ERA analysis, denial trends)
  • Time Management & Prioritization
  • Collaboration & Provider Education
  • Professionalism & Patient Service

BENEFITS AND PERKS
  • Health benefits including medical, vision, dental, life, disability
  • Generous Paid Time Off
  • 10 Paid Holidays
  • Student loan forgiveness opportunities
  • Employee Assistance Program (EAP) with access to various consultants
  • 3% match toward retirement fund
  • And more!

LIVING OUR VALUES
You are mission-oriented and passionate about living out your purpose. You play an active role in responding to the needs of the community and organization. You work well alongside your teammates and use your time and resources effectively. You challenge yourself to grow personally and professionally. You embrace diversity and enjoy providing your customers with excellent treatment and compassion.
Required Qualifications
  • High school diploma or equivalent required.
  • Active billing/coding certification.
  • 1-3+ years of recent medical billing/coding experience in an outpatient, inpatient, or specialty setting.
  • Proficiency with EHR/PM systems (e.g., Epic) and clearinghouses.
  • Working knowledge of ICD-10-CM, CPT/HCPCS, modifiers, payer rules, and claims lifecycles (837/835).
  • Strong understanding of denials management, aging A/R, and reconciliation.
  • High attention to detail; ability to meet volume and accuracy targets.
  • Excellent communication and customer service skills.

Preferred Qualifications
  • Experience in [primary care, behavioral health, etc.]
  • Familiarity with Medicare LCD/NCD guidance and state-specific Medicaid policies.
  • Knowledge of risk adjustment (HCC), HEDIS-quality documentation, and prior auth workflows.

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