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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 · Remote

$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 ...

Intermountain Health

HCC Coding Analyst 1

Nashville, TN · On-site

$28.06 - $44.20/hr

... Risk Adjustment Coding for highly regulated government insurance programs such as Medicare Advantage (MA), Medicaid, and the Affordable Care Act (ACA). This analyst will audit approved clinical ...

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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 7, 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 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?

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.

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?

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 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, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 88% Physical, 5% Hybrid, and 7% Remote job distribution, with an average salary of $42,325 per year, or $20.3 per hour.

Principal, Risk Adjustment Analytics Consultant - REMOTE

Health Care Service Corporation

Nashville, TN • On-site, Remote

$102K - $184K/yr

Full-time

Medical, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary
The Principal Risk Adjustment Consultant drives analytical strategies and solutions to optimize Medicare Risk Adjustment (RA) performance. Leveraging deep healthcare expertise and advanced coding proficiency, this role delivers actionable insights, builds dynamic visualizations, and provides strategic advisory services to internal stakeholders and senior leadership.
Core responsibilities include analyses for revenue optimization, risk forecasts, HCC coding logic, RADV audits, Medicare segmentation, data & logic governance. The Principal Risk Adjustment Consultant will build interactive visualizations, interpret CMS model updates that affect organization-wide strategy and risk adjustment analytics and translate highly technical coding, regulatory, and statistical nuances into clear business recommendations for executive leadership
Required Job Qualifications:
  • Bachelor's degree and 8 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR Master's degree with 6 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR PhD with 4 years of experience in health care services, statistical analysis, or insurance industry economics or related field OR 12 years of experience in health care services, statistical analysis, or insurance industry economics or related field

  • Understanding, and being highly proficient at querying a wide variety of internal and external data sources to get meaningful insights.

  • Strong analytical skills and proficiency in computer languages, such as SQL, Python, R, etc.

  • Ability to create a dynamic and visually engaging dashboard leveraging data visualization tools such as Tableau or Power BI.

  • High degree of business intelligence and understanding how to take a business case from inception to customer or partner execution.

  • Excellent communication and presentation skills.

  • Ability to work independently and as part of a team.

  • Ability to lead multiple analytic related projects in parallel.

  • Analytics subject matter expert

  • Performance excellence in championing initiatives and collaborating with multiple stakeholders to bring the initiative to life.

  • Ability to work under pressure and delivery high quality output to senior leadership to decision making within short timeline.

Preferred Job Qualifications:
  • Deep experience with Medicare Risk Adjustment and Stars.

  • Advanced analytics & automation using Alteryx or Airflow for data blending and automation.

  • Proficiency with GitHub for collaborative coding and version control.

  • Certification or practical experience with project management methodologies and tracking tools (e.g., Agile, Wrike, PMP), and exposure to data science in healthcare including hands-on experience working with predictive models, machine learning pipelines, or Large Language Models (LLMs).

This is a Remote role.
#LI-PD1
#LI-REMOTE
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement:
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
HCSC Employment Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range
$102,000.00 - $184,300.00
Exact compensation may vary based on skills, experience, and location.

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