Risk Adjustment and Revenue Performance: * Develop and maintain models to forecast risk-adjusted revenue across Medicare Advantage contracts * Analyze historical risk score trends, RAF accuracy, and ...
Risk Adjustment and Revenue Performance: * Develop and maintain models to forecast risk-adjusted revenue across Medicare Advantage contracts * Analyze historical risk score trends, RAF accuracy, and ...
Risk Adjustment and Revenue Performance: * Develop and maintain models to forecast risk-adjusted revenue across Medicare Advantage contracts * Analyze historical risk score trends, RAF accuracy, and ...
Risk Adjustment and Revenue Performance: * Develop and maintain models to forecast risk-adjusted revenue across Medicare Advantage contracts * Analyze historical risk score trends, RAF accuracy, and ...
Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and ...
New
Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and ...
New
Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and ...
New
Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and ...
New
Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment. * Current state medical license without restrictions to practice and free of ...
Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment. * Current state medical license without restrictions to practice and free of ...
Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment. * Current state medical license without restrictions to practice and free of ...
Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment. * Current state medical license without restrictions to practice and free of ...
Coding Auditor Sr. (CareBridge)
Nashville, TN · On-site
$26.25 - $30/hr
Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... Experience working with Medicare is preferred. * Experience with ICD-9 coding a plus. Please be ...
New
Coding Auditor Sr. (CareBridge)
Nashville, TN · On-site
$26.25 - $30/hr
Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... Experience working with Medicare is preferred. * Experience with ICD-9 coding a plus. Please be ...
New
Coding Auditor Sr. (CareBridge)
Nashville, TN · On-site
$26.25 - $30/hr
Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... Experience working with Medicare is preferred. * Experience with ICD-9 coding a plus. Job Level:
New
Coding Auditor Sr. (CareBridge)
Nashville, TN · On-site
$26.25 - $30/hr
Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... Experience working with Medicare is preferred. * Experience with ICD-9 coding a plus. Job Level:
New
Coding Auditor Sr. (CareBridge)
Nashville, TN · On-site
$26.25 - $30/hr
Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... Experience working with Medicare is preferred. * Experience with ICD-9 coding a plus. Please be ...
Coding Auditor Sr. (CareBridge)
Nashville, TN · On-site
$26.25 - $30/hr
Assists with National and Targeted Risk Adjustment Data Validation audits. * Participates and ... Experience working with Medicare is preferred. * Experience with ICD-9 coding a plus. Please be ...
... Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and Medicare clinical quality via HEDIS, meeting local and organizational goals • Personally ...
... Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and Medicare clinical quality via HEDIS, meeting local and organizational goals • Personally ...
... Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and Medicare clinical quality via HEDIS, meeting local and organizational goals • Personally ...
... Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and Medicare clinical quality via HEDIS, meeting local and organizational goals • Personally ...
Medical Director Physician
Nashville, TN · On-site
... Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and Medicare clinical quality via HEDIS, meeting local and organizational goals • Personally ...
Medical Director Physician
Nashville, TN · On-site
... Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical ... and Medicare clinical quality via HEDIS, meeting local and organizational goals • Personally ...
Clinical Pharmacist (MTM) - Work From Home
Nashville, TN · Remote
$102K - $184K/yr
... high-risk populations. These reviews include but are not limited to the assessment of drug ... Minimum 3 years' experience in Managed Care, Medicare and/orMedicaid settingspreferred * Experience ...
Clinical Pharmacist (MTM) - Work From Home
Nashville, TN · Remote
$102K - $184K/yr
... high-risk populations. These reviews include but are not limited to the assessment of drug ... Minimum 3 years' experience in Managed Care, Medicare and/orMedicaid settingspreferred * Experience ...
Clinical Pharmacist (MTM) - Work From Home
Nashville, TN · On-site +1
$102K - $184K/yr
... high-risk populations. These reviews include but are not limited to the assessment of drug ... Minimum 3 years' experience in Managed Care, Medicare and/or Medicaid settings preferred
Clinical Pharmacist (MTM) - Work From Home
Nashville, TN · On-site +1
$102K - $184K/yr
... high-risk populations. These reviews include but are not limited to the assessment of drug ... Minimum 3 years' experience in Managed Care, Medicare and/or Medicaid settings preferred
Senior Claims Representative (Remote)
Columbia, TN · On-site +1
Review and authorize large or complex medical bills, negotiating adjustments to control costs ... Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
Senior Claims Representative (Remote)
Columbia, TN · On-site +1
Review and authorize large or complex medical bills, negotiating adjustments to control costs ... Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
Medical Social Worker
Memphis, TN · On-site
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medical Social Worker
Memphis, TN · On-site
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medical Social Worker
Memphis, TN · On-site
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medical Social Worker
Memphis, TN · On-site
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medical Social Worker
Memphis, TN · On-site
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medical Social Worker
Memphis, TN · On-site
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medical Social Worker
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medical Social Worker
$43K - $91K/yr
... risk patients and their caregivers to help them improve their health status and avoid ... Passion for working with Medicare-eligible populations, including older adults, adults with ...
Medicare Risk Adjustment information
See Tennessee salary details
$11.56 - $13.82
16% of jobs
$14.41 is the 25th percentile. Wages below this are outliers.
$13.82 - $16.09
34% of jobs
$16.09 - $18.35
18% of jobs
$18.35 - $20.61
1% of jobs
$21.80 is the 75th percentile. Wages above this are outliers.
$20.61 - $22.87
10% of jobs
$22.87 - $25.13
4% of jobs
$25.13 - $27.39
3% of jobs
$27.39 - $29.65
2% of jobs
$29.65 - $31.91
9% of jobs
$31.91 - $34.17
0% of jobs
$34.17 - $36.44
2% of jobs
$11
$20
$36
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?
| 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?
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:
Full-time
Re-posted 8 days ago
ArchWell Health rating
8.0
Based on 20 frontline employees who took The Breakroom Quiz
3rd of 239 rated social care providers
Job description
Senior Actuarial Analyst
Job Summary:
The Senior Actuarial Analyst will play a pivotal role in ArchWell Health's growth and within the Actuarial Department. This Analyst's contribution will be key to the organization's collective success. This role will work closely and collaboratively with various departments, providing insights that support strategic business decisions and optimize financial performance.
Department Duties/Responsibilities:
Required Skills/Abilities:
Minimum Qualifications:
About ArchWell Health:
At ArchWell Health, we're creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.
Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We're passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.
Job Summary:
The Senior Actuarial Analyst will play a pivotal role in ArchWell Health's growth and within the Actuarial Department. This Analyst's contribution will be key to the organization's collective success. This role will work closely and collaboratively with various departments, providing insights that support strategic business decisions and optimize financial performance.
Department Duties/Responsibilities:
- Risk Adjustment and Revenue Performance:
- Develop and maintain models to forecast risk-adjusted revenue across Medicare Advantage contracts
- Analyze historical risk score trends, RAF accuracy, and coding opportunities to identify gaps and performance drivers
- Support the annual budget process, quarterly projections, monthly accruals, and variance explanations
- Evaluate the impact of HCC model updates and CMS rule changes on organizational revenue
- Perform Ad-hoc Revenue Analysis to evaluate financial impacts of operational initiatives, clinical programs, membership shifts, and emergent business questions
- Reserving and Monthly Close processes:
- Assist in monthly IBNR development and selection process.
- Prepare necessary monthly reporting as a key contributor within the monthly closing cycle.
- Forecast and Modeling:
- Develop and maintain models to forecast future medical cost and revenue and/or evaluate the financial impact of various interventions.
- Partner with department heads to understand key business drivers and assumptions, ensuring alignment with strategic objectives.
- Prepare comprehensive financial reports and variance analyses for senior management and key stakeholders.
- Conduct ad hoc financial analyses to support special projects, strategic initiatives, and investment opportunities.
- Data Analysis:
- Analyze payor healthcare data (claims, utilization, costs) to identify trends, cost drivers, and opportunities for improvement.
- End to end payor reconciliations (detail vs summary, external vs internal data feeds, and additional reconciliation as needed).
- Payor outreach and internal point of contact related to file requests, data gaps, and other supplemental reporting and information available
- Business Performance Monitoring:
- Monitor and analyze key performance indicators (KPIs) and operational metrics to assess business performance and identify areas of improvement.
- Collaborate with operational teams to develop actionable insights and recommendations for performance enhancement and risk mitigation.
- Evaluate the cost-effectiveness and value of different healthcare interventions, programs, and policies.
- Assist in the development of executive-level dashboards and reporting tools to track financial and operational performance against targets.
- Cross-Functional Collaboration:
- Collaborate cross-functionally with IT, finance, accounting, operations, and other departments to streamline processes, improve data accuracy, and enhance financial reporting capabilities.
Required Skills/Abilities:
- Prior experience within Medicare Advantage
- Understanding of CMS-HCC models (v24/v28), CMS risk adjustment methodology, and RAF score calculation
- Proficiency in modeling, forecasting, and/or variance analysis
- Advanced proficiency in Microsoft Excel
- Prior usage and strong understanding of SQL (2+ years preferred)
- Understanding of profit and loss statements and ability to work with larger datasets behind them
- Analytical, problem-solving, and critical thinking skills
- Ability to work effectively in a fast-paced, dynamic environment and managing multiple priorities simultaneously
- Strong interpersonal skills with the ability to collaborate cross-functionally and build positive working relationships at all levels of the organization.
- Occasional travel required, no more than 10%-15%
Minimum Qualifications:
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, Finance, Economics, or related field required; MBA or advanced degree preferred.
- At least of 3-6 years relevant Actuarial experience within healthcare preferred.
- 2+ Actuarial Exams, Pre-ASA or ASA level
- Embodies and serves as a role model of ArchWell Health's Values:
- Be compassionate
- Strive for excellence
- Earn trust
- Show respect
- Stay resilient
- Always do the right thing
About ArchWell Health:
At ArchWell Health, we're creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.
Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We're passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.
ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.
What ArchWell Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About ArchWell Health
Sourced by ZipRecruiter
At ArchWell Health, we help our members lead healthier lives through superior senior primary care and stronger patient-to-doctor relationships. You’ll find plenty of reasons to love being an ArchWell Health member. You’ll also discover that they add up to something huge—a healthier and happier you.
Industry
Outpatient health care
Company size
11 - 50 Employees
Headquarters location
Nashville, TN, US
Year founded
2020