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Medicare Risk Adjustment Jobs in Virginia (NOW HIRING)

Overview Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs ...

Medical Coding Educator

Richmond, VA · On-site

$27 - $30.75/hr

Will report to the Manager, Medicare Risk Adjustment. As the Medical Coding Educator 2 you will * Arrange educational sessions with assigned providers aimed at quality of care and documentation ...

New

Actuary

Richmond, VA · Remote

$150/hr

Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models * Experience working with CMS and CMMI total cost of care (ACO) programs * Proven track record ...

The candidate will serve as the Product Analyst/Scrum Master fora developmentteam responsible for executing risk adjustment model runsat the Centers for Medicare & Medicaid.The individual ...

Senior Health Data Analyst

Tysons, VA · On-site

$92K - $158K/yr

He/She will use strong data analysis skills (e.g., SAS/SQL/Python/Excel) to produce reports and insights that inform Medicare and Medicare Advantage policy including related to risk adjustment.

Senior Health Data Analyst

Tysons, VA · On-site

$92K - $158K/yr

He/She will use strong data analysis skills (e.g., SAS/SQL/Python/Excel) to produce reports and insights that inform Medicare and Medicare Advantage policy including related to risk adjustment.

He/She will use strong data analysis skills (e.g., SAS/SQL/Python/Excel) to produce reports and insights that inform Medicare and Medicare Advantage policy including related to risk adjustment.

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Medicare Risk Adjustment information

See Virginia salary details

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How much do medicare risk adjustment jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for medicare risk adjustment in Virginia is $22.23, according to ZipRecruiter salary data. Most workers in this role earn between $15.96 and $26.92 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.
What are the most commonly searched types of Medicare Risk Adjustment jobs in Virginia? The most popular types of Medicare Risk Adjustment jobs in Virginia are:
What are popular job titles related to Medicare Risk Adjustment jobs in Virginia? For Medicare Risk Adjustment jobs in Virginia, the most frequently searched job titles are:
What cities in Virginia are hiring for Medicare Risk Adjustment jobs? Cities in Virginia with the most Medicare Risk Adjustment job openings:
Infographic showing various Medicare Risk Adjustment job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, and 4% Contract. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution, with an average salary of $46,233 per year, or $22.2 per hour.

Risk Adjustment Coder

Sentara Health

Virginia Beach, VA • Hybrid

$10K/mo

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.


Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 398 frontline employees who took The Breakroom Quiz

491st of 887 rated healthcare providers


Job description

City/State
Virginia Beach, VA
Work Shift
First (Days)
Overview:
Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA!
Hours:Monday - Friday, 8:00AM -5:00PM, dayshift.
This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week. The role also includes travel as needed to support business objectives and team collaboration.
Overview
Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training, monitoring, & auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. Performs vendor quality oversight audits; reviews and/or makes final coding determination for non-agreeable coding. Makes final decision on vendor-to-vendor diagnosis coding rebuttal concerns. Serves as subject matter expert on risk adjustment diagnosis coding guidelines. Coordinates risk adjustment gap elimination with clinical and quality gap elimination Maintains a reasonable fluency in workings & financial implications of applicable risk adjustment models.
Education
  • Associate degree ( Required )

Experience
  • Medical Records Data - 1 year ( Required )
  • Coding - 2 years ( Required )

Certifications:
One of the following certifications are required: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist-Physician-based (CCS-P), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).
Must obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment.
Keywords: Risk Adjustment Coding & Documentation Specialist, Talroo-Allied Health, Medical Office
Benefits: Caring For Your Family and Your Career
Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
•Pet Insurance
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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