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Medicare Risk Adjustment Jobs in Virginia (NOW HIRING)

Ennoble Care

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 ...

LMI

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.

LMI

Senior Health Data Analyst

Tysons, VA

$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.

LMI

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.

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All JobsMedicare Risk Adjustment JobsMedicare Risk Adjustment Jobs in Virginia

Medicare Risk Adjustment information

See Virginia salary details

$12

$22

$39

How much do medicare risk adjustment jobs pay per hour?

As of Jul 30, 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, and why are they important?

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 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 job categories do people searching Medicare Risk Adjustment jobs in Virginia look for? The top searched job categories for Medicare Risk Adjustment jobs in Virginia are:
What cities in Virginia are hiring for Medicare Risk Adjustment jobs? Cities in Virginia with the most Medicare Risk Adjustment job openings:
Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Virginia as of July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $46,233 per year, or $22.2 per hour.

Actuary

Ennoble Care

Richmond, VA • Remote

$150/hr

Full-time

Re-posted 12 days ago

Ennoble Care rating

4.2

Company rating: 4.2 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

About Us

Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, "To Care is an Honor." Join Ennoble Care today!

Position Overview

We are seeking an experienced Actuary (5+ years of experience) for our value-based care (VBC) team. This role requires a seasoned professional in medical economics, actuarial, or equivalent data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes. Candidates will ideally have their ASA certification or have passed at least the first three exams.

This role is currently scoped as an individual contributor, with a growth trajectory toward leadership over time.

Key ResponsibilitiesData Management & Medicare Analytics
  • Analyze VBC performance under various CMS and CMMI total cost-of-care models.
  • Monitor and forecast financial performance across assigned patient populations.
  • Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets.
  • Refine key reporting and projection methodologies, including IBNR and Risk Score projections.
  • Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
  • Ensure data quality and integrity across all analytical processes.
  • Develop and maintain SQL-based data structures to support population experience studies and VBC program analytics.
Business Intelligence & Reporting
  • Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
  • Develop executive dashboards and performance metrics aligned with organizational strategic goals.
  • Present findings and recommendations to leadership teams and clinical stakeholders.
  • Support budget planning and financial forecasting processes.
Regulatory Compliance & Process Improvement
  • Stay current with evolving CMS and CMMI program requirements and quality measures.
Required QualificationsEducation & Certification
  • Bachelor's degree in Actuarial Science, Statistics, Mathematics, Data Science, or related quantitative field
  • ASA credentials preferred for Actuarial candidates
Experience Requirements
  • Strong healthcare data analytics experience in Medicare-focused or Medicare Advantage environments (5+ years of experience)
  • 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 spearheading claims analytics using Medicare claims data
  • In-depth knowledge of healthcare billing processes from both provider and CMS perspectives
Technical Proficiency
  • Advanced proficiency in Microsoft Excel and model building
  • Strong SQL skills with the ability to write complex queries
  • Experience with the Microsoft Azure cloud platform and related analytics tools preferred
  • Experience with integrating data across multiple large, nuanced data sources (e.g., integration of EHR data with claims datasets)
  • Experience developing/integrating AI-forward workflows into analytics
Core Competencies
  • Exceptional analytical and problem-solving capabilities
  • Strong business acumen with the ability to translate technical findings into strategic recommendations
  • Excellent written and verbal communication skills for both technical and non-technical audiences
  • Proven team player with a collaborative approach to cross-functional projects
  • Demonstrated capability to understand and respond to evolving business needs
Compensation
  • The salary range is $150- 170k with a $30- 40k bonus range

Full-time employees qualify for the following benefits:

  • Medical, Dental, Vision and supplementary benefits such as Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity.
  • Paid Time Off
  • Paid Office Holidays

All employees qualify for these benefits:

  • Paid Sick Time
  • 401(k) with up to 3% company match
  • Referral Program
  • Payactiv: pay-on-demand. Cash out earned money when and where you need it!

Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) before an offer of employment is extended.

Ennoble Care is an Equal Opportunity Employer, committed to hiring the best team possible, and does not discriminate against protected characteristics including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.

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