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Medicare Risk Adjustment Jobs in Tennessee (NOW HIRING)

Vertek Staffing

HCC Risk Adjustment Coder

Franklin, TN · Remote

$18 - $24/hr

HCC / Risk Adjustment Coder - Remote Risk Adjustment / HCC Coding Experience Required Required ... Experience with Medicare Advantage populations * Experience with value-based care programs

Urrly

Telehealth Nurse Practitioner

Nashville, TN · On-site +1

$600 - $720/day

Familiar with HEDIS and risk adjustment workflows * Medicare and Medicaid provider enrollment required * Comfortable delivering care through telehealth platforms * Ability to consistently work ...

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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 29, 2026, the average hourly pay for medicare risk adjustment in Tennessee is $20.35, according to ZipRecruiter salary data. Most workers in this role earn between $14.62 and $24.66 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 Tennessee?

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

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

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

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

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

Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Tennessee 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 $42,325 per year, or $20.3 per hour.

Risk Adjustment Expert - AI Trainer

Nashville, TN • Remote

Mercor
See more jobs at Mercorexternal

$110/hr

Full-time

Posted 10 days ago

Job description

About the job

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Risk-adjustment / HCC coding leader
Type: Contract
Compensation: $110/hour
Location: Remote

Role Responsibilities

  • Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA risk adjustment programs.
  • Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy and regulatory compliance.
  • Review medical records to ensure complete and accurate capture of HCC-eligible conditions supported by clinical documentation.
  • Conduct and oversee retrospective and prospective chart reviews for risk score optimization.
  • Manage RADV audit preparation and response processes.
  • Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes.

Qualifications

Must-Have

  • 5+ years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations, with at least 2 years in a leadership role.
  • Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologies.
  • Strong knowledge of ICD-10-CM coding guidelines as applied to HCC risk adjustment.
  • Experience with RADV audit preparation and CMS compliance requirements.
  • Familiarity with RAPS and EDGE submission processes.
  • Exceptional written and verbal English communication skills.
  • High attention to detail with the ability to identify coding inaccuracies and documentation gaps in AI-generated outputs.

Preferred

  • CRC (Certified Risk Coder), CCS, CPC, or RHIA credential.
  • Experience with risk adjustment analytics platforms and chart retrieval systems.
  • Background in health plan, Medicare Advantage organization, or value-based care setting.
  • Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content.
  • Experience presenting risk adjustment performance to actuarial or executive teams.

Application Process (Takes 20–30 mins to complete)

  • Upload resume
  • AI interview based on your resume
  • Submit form

Resources & Support

  • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
  • For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.


#hiringmercor