Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models * Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs * Proven track ...
Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models * Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs * Proven track ...
Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations ...
Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, CMS STARs/HEDIS, and overall population health approach to patient care in both formal presentations ...
Senior Financial Analytics Professional
Ashburn, VA · On-site
$89 - $121/hr
The MRA Finance team supports Humana's Risk Adjustment business area, part of the Medicare business. Medicare Advantage remains Humana's largest business, serving millions of members nationwide and ...
New
Senior Financial Analytics Professional
Ashburn, VA · On-site
$89 - $121/hr
The MRA Finance team supports Humana's Risk Adjustment business area, part of the Medicare business. Medicare Advantage remains Humana's largest business, serving millions of members nationwide and ...
New
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Hierarchical Condition Category (HCC) Coding Specialist
Richmond, VA · On-site
$41.85/hr
... Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and ...
Hierarchical Condition Category (HCC) Coding Specialist
Richmond, VA · On-site
$41.85/hr
... Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and ...
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA. This unique ...
Quick apply
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA. This unique ...
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Waynesboro, VA · On-site
$104K - $135K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA.
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Waynesboro, VA · On-site
$104K - $135K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Waynesboro, VA.
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA. This unique ...
Quick apply
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA. This unique ...
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Harrisonburg, VA · On-site
$101K - $131K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA.
Nurse Practitioner or Physician Assistant (PRN) - Health Risk Assessments
Harrisonburg, VA · On-site
$101K - $131K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Harrisonburg, VA.
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations
Arlington, VA · On-site
... Medicare Advantage reimbursement models-all while raising the bar on the member financial ... HCC) risk-adjustment coding accuracy and documentation integrity About the team The Healthcare ...
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$106K - $138K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Montross, VA This unique ...
Quick apply
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$106K - $138K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Montross, VA This unique ...
Nurse Practitioner NP or Physician Assistant PA-C, PRN, HRA
Meherrin, VA · On-site
$107K - $138K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Meherrin, VA.
Nurse Practitioner NP or Physician Assistant PA-C, PRN, HRA
Meherrin, VA · On-site
$107K - $138K/yr
Description Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Meherrin, VA.
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$105K - $135K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Chase City, VA. This unique ...
Quick apply
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$105K - $135K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Chase City, VA. This unique ...
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$95K - $124K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Heatherville, VA. This unique ...
Quick apply
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$95K - $124K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Heatherville, VA. This unique ...
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$107K - $138K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Staunton, VA. This unique ...
Quick apply
Nurse Practitioner NP or Physician Assistant PA-C, Part-Time, HRA *$2,000 Sign On Bonus*
$107K - $138K/yr
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Staunton, VA. This unique ...
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Meherrin, VA. This unique ...
Quick apply
Hueman is actively hiring Nurse Practitioners and Physician Assistants to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Meherrin, VA. This unique ...
Director, Actuarial
Norfolk, VA · On-site
$120 - $150/hr
... Medicare and Medicaid lines of business. This role is critical to ensuring market-competitive ... Risk Adjustment, and Clinical teams to drive enterprise value and support SHP's growth strategy.
Director, Actuarial
Norfolk, VA · On-site
$120 - $150/hr
... Medicare and Medicaid lines of business. This role is critical to ensuring market-competitive ... Risk Adjustment, and Clinical teams to drive enterprise value and support SHP's growth strategy.
CMS or Medicare Advantage / Part D risk adjustment domain knowledge; familiarity with encounter data. * Experience supporting data-processing or model-execution teams (Python-based pipelines, data ...
CMS or Medicare Advantage / Part D risk adjustment domain knowledge; familiarity with encounter data. * Experience supporting data-processing or model-execution teams (Python-based pipelines, data ...
Senior Product Analyst
Arlington, VA · On-site
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 Product Analyst
Arlington, VA · On-site
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 ...
Medicare Risk Adjustment information
See Virginia salary details
$12.63 - $15.10
16% of jobs
$15.74 is the 25th percentile. Wages below this are outliers.
$15.10 - $17.57
34% of jobs
$17.57 - $20.04
18% of jobs
$20.04 - $22.51
1% of jobs
$23.81 is the 75th percentile. Wages above this are outliers.
$22.51 - $24.98
10% of jobs
$24.98 - $27.45
4% of jobs
$27.45 - $29.92
3% of jobs
$29.92 - $32.39
2% of jobs
$32.39 - $34.86
9% of jobs
$34.86 - $37.33
0% of jobs
$37.33 - $39.80
2% of jobs
$12
$22
$39
How much do medicare risk adjustment jobs pay per hour?
What is Medicare Risk Adjustment?
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?
What are some common challenges faced by professionals working in Medicare Risk Adjustment roles?
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 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:

Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 7 days ago
Ennoble Care rating
4.2
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!
We are seeking an experienced Sr. Medical Economics Analyst to join our value-based care (VBC) team in our Accountable Care Organization (ACO). This role requires a seasoned professional with 3-5 years of 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.
Key ResponsibilitiesRisk Assessment & Medicare Analytics
- Develop and maintain sophisticated risk-adjusted provider group performance models using CMS-HCC methodology.
- 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, including simulating CMS-HCC risk adjustment.
Data Management & Analytics
- 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.
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.
- Collaborate with revenue cycle and coding teams to optimize documentation and billing accuracy.
Education & Certification
- Bachelor's degree in Data Science, Statistics, Mathematics, Economics, Business Administration or related quantitative field
Experience Requirements
- 3-5 years of data analytics experience, preferably in healthcare or Medicare-focused environments
- Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models
- Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs
- Proven track record analyzing Medicare claims data, specifically CCLF and BCDA datasets
- In-depth knowledge of healthcare billing processes from both provider and CMS perspectives
Technical Proficiency
- Advanced proficiency in Microsoft Excel (pivot tables, complex formulas, VBA preferred)
- Strong SQL skills with ability to write complex queries and optimize database performance
- Experience with Microsoft Azure cloud platform and related analytics tools
- Proven ability to work with very large datasets (multi-million row files) and combine data from multiple sources
- Experience integrating EHR data with claims datasets for comprehensive population health analysis
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
Location: Fully Remote (with up to 10% travel)
This position requires the ability to work with sensitive healthcare information and maintain strict confidentiality in accordance with HIPAA and other applicable regulations.
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.
What Ennoble Care employees say
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Ennoble Care
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
201 - 500 Employees
Headquarters location
Hackensack, NJ, US