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Medicare Risk Adjustment Jobs in Virginia (NOW HIRING)

LMI

Health Data Engineer - Mid

Tysons, VA · On-site

$115K - $139K/yr

... Medicare Advantage, and risk adjustment. The ideal candidate will bring a strong background in data engineering and analytics, as well as familiarity with healthcare data and compliance requirements.

LMI

Health Data Engineer - Mid

Tysons, VA · On-site

$115K - $139K/yr

... Medicare Advantage, and risk adjustment. The ideal candidate will bring a strong background in data engineering and analytics, as well as familiarity with healthcare data and compliance requirements.

LMI Consulting, LLC

Health Data Engineer - Mid

Tysons, VA · On-site

$115K - $139K/yr

... Medicare Advantage, and risk adjustment. The ideal candidate will bring a strong background in data engineering and analytics, as well as familiarity with healthcare data and compliance requirements.

LMI

Health Data Engineer - Mid

Tysons, VA

$115K - $139K/yr

... Medicare Advantage, and risk adjustment. The ideal candidate will bring a strong background in data engineering and analytics, as well as familiarity with healthcare data and compliance requirements.

Alternate Solutions Health

Physical Therapist

Fairfax, VA · On-site

$1.7K - $2.2K/wk

Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for ... Minimize Patient Risk: Helps decrease re-hospitalizations by front loading visits for high risk ...

Alternate Solutions Health

Physical Therapist

Fairfax, VA

$1.7K - $2.2K/wk

Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for ... Minimize Patient Risk: Helps decrease re-hospitalizations by front loading visits for high risk ...

W3Global Inc.

Chief Resident Services Officer

Manassas, VA · On-site

$200K - $225K/yr

Medicare fraud and abuse issues. 14 Develops and implements the Ethics and Quality Assurance and ... and Risk Management programs for the Nursing Home and Assisted Living facilities and related ...

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All JobsMedicare Risk Adjustment JobsMedicare Risk Adjustment Jobs in Virginia

Medicare Risk Adjustment information

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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.
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 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.

Medical Director, Quality and Value-Based Performance

Wapa

Newport News, VA • On-site

$233 - $302/hr

Other

Re-posted 4 days ago

Job description

Medical Director, Quality and Value-Based Performance

Riverside Medical Group is seeking a physician leader to serve as Medical Director of Quality and Value-Based Performance. This is a highly visible role focused on advancing value-based care across a growing, integrated health system. This opportunity offers the ability to shape strategy, influence outcomes, and partner directly with clinical and executive leadership to drive performance across MSSP and commercial value-based arrangements.

About the Role

The Medical Director will provide physician leadership across all value-based initiatives, with a focus on improving quality, outcomes, utilization, and financial performance through data-driven strategies and strong collaboration. This leader will play a key role in advancing Riverside’s participation in the Medicare Shared Savings Program and other payer programs, while helping standardize care delivery and elevate performance across the organization.

Key Responsibilities
  • Lead value-based performance initiatives across MSSP and commercial payer arrangements
  • Partner with physicians, advanced practice providers, and operational leaders to drive quality and utilization improvement
  • Analyze performance data and develop actionable strategies to improve outcomes and cost of care
  • Oversee development and implementation of population health dashboards and provider scorecards
  • Standardize clinical workflows and evidence-based protocols to enhance efficiency and care quality
  • Serve as Medical Director for ACO initiatives and participate in ACO governance and operations
  • Collaborate with payer partners and lead performance reviews, gap closure efforts, and improvement cycles
What Makes This Role Unique
  • Enterprise-level influence across a respected, physician-led organization
  • Direct impact on clinical quality, financial performance, and patient outcomes
  • Close collaboration with executive leadership and payer partners
  • Opportunity to help shape and scale a mature and evolving value-based care strategy
Qualifications
  • MD or DO, Board Certified in Internal Medicine, Family Medicine, Emergency Medicine, or Pediatrics
  • Eligible for or currently holding a Virginia medical license
  • 10+ years of experience, including meaningful involvement in value-based care models
  • Demonstrated experience with MSSP, ACOs, or other risk-based arrangements
  • Strong understanding of HCC risk adjustment, population health management, and utilization performance
  • Familiarity with payer performance, cost structures, and medical loss ratios
  • Experience working with data, dashboards, and performance reporting tools (Epic preferred)
  • Proven leadership, communication, and change management skills
About Riverside Medical Group

Riverside Medical Group is part of Riverside Health System, a mission-driven, physician-led organization committed to advancing care delivery across the region. With a strong foundation in quality and a growing focus on value-based care, Riverside offers an environment where physician leaders can make a meaningful and lasting impact.

Hiring Range

$233,000 - $302,000

Actual pay depends on specialty, experience and performance

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