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Medicare Risk Adjustment Jobs in Wisconsin (NOW HIRING)

Urrly

Telehealth Nurse Practitioner

Madison, WI · Remote

$600 - $720/day

Familiar with HEDIS and risk adjustment workflows * Medicare and Medicaid provider enrollment required * Comfortable delivering care through telehealth platforms * Ability to consistently work ...

Palm Medical Centers

WI · On-site

$200 - $300/hr

Provide comprehensive primary care services to adult and senior population within the Medicare ... Strong understanding of HEDIS, STAR ratings, risk adjustment, and preventative care measures.

All JobsMedicare Risk Adjustment JobsMedicare Risk Adjustment Jobs in Wisconsin

Medicare Risk Adjustment information

See Wisconsin salary details

$12

$22

$40

How much do medicare risk adjustment jobs pay per hour?

As of Jul 31, 2026, the average hourly pay for medicare risk adjustment in Wisconsin is $22.63, according to ZipRecruiter salary data. Most workers in this role earn between $16.25 and $27.40 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 Wisconsin? The most popular types of Medicare Risk Adjustment jobs in Wisconsin are:
What are popular job titles related to Medicare Risk Adjustment jobs in Wisconsin? For Medicare Risk Adjustment jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment jobs in Wisconsin look for? The top searched job categories for Medicare Risk Adjustment jobs in Wisconsin are:
Medicare Risk Adjustment jobs near you
Infographic showing various Medicare Risk Adjustment job openings in Wisconsin as of July 2026, with employment types broken down into 1% As Needed, 76% Full Time, 15% Part Time, and 8% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $47,069 per year, or $22.6 per hour.

Risk Adjustment Compliance Project Manager

Imedica

Madison, WI • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 15 days ago

Job description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.  

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.  

The Risk Adjustment Compliance Project Manager is responsible for leading compliance focused initiatives that ensure the accuracy, integrity, and regulatory adherence of Medica’s Risk Adjustment programs across Medicare Advantage, Medicaid, and ACA lines of business. This role provides subject matter expertise in regulatory requirements, audit readiness, and governance, and serves as a cross functional project leader for compliance, audit, and documentation initiatives. The Risk Adjustment Compliance Project Manager plays a critical role in maintaining audit readiness, mitigating compliance risk, and ensuring risk adjustment policies, procedures, and provider education aligning with CMS and state regulations.

Key Accountabilities

Audit Oversight & Readiness

  • Coordinate and support internal and external audits, including RADV and other regulatory or operational reviews
  • Serve as the primary point of coordination for audit requests, documentation retrieval, validation, and submission
  • Track audit findings and collaborate with stakeholders on corrective action plans and remediation efforts
  • Support ongoing audit readiness by strengthening controls, workflows, and documentation standards

Policy & Procedure Management 

  • Develop, maintain, and update Risk Adjustment policies, procedures, and standard operating documentation
  • Ensure documentation reflects current regulatory guidance, operational practice, and internal control requirements
  • Partner with Compliance and Operational leaders to ensure consistent application and understanding of policies
  • Maintain auditready documentation, including version control and governance standards

Risk Adjustment Compliance & Governance

  • Lead Risk Adjustment compliance initiatives to ensure adherence to CMS and state regulatory requirements
  • Interpret and operationalize regulatory guidance impacting risk adjustment documentation, submission, and oversight
  • Partner closely with Compliance, Quality, Legal, and Risk Adjustment Operations to align compliance activities with enterprise standards
  • Identify compliance risks, gaps, and trends, and drive mitigation strategies to reduce regulatory exposure

Provider Education & Documentation Integrity 

  • Collaborate with Provider Engagement and Quality teams to support provider education related to compliant documentation and risk adjustment standards
  • Ensure provider education materials align with regulatory requirements and Medica compliance expectations
  • Act as a subject matter expert for documentation and compliancerelated questions impacting providers and internal teams

Project Management & Continuous Improvement

  • Lead compliancedriven risk adjustment projects from planning through execution
  • Coordinate crossfunctional efforts to implement regulatory changes or compliance improvements
  • Identify and implement process improvements that strengthen program integrity and operational effectiveness
  • Provide compliance status updates and reporting to leadership as needed

Required Qualifications 

  • Bachelor’s degree in Healthcare Administration, Business, Health Information Management, Compliance, or related field
  • 5+ years of experience in healthcare operations, risk adjustment, healthcare compliance and/or audit, or regulatory support

Preferred Qualifications 

  • Experience supporting RADV or CMS or DHS compliance audits
  • Background in provider education, clinical documentation, or coding compliance
  • Experience developing and maintaining healthcare policies and procedures
  • Experience supporting Medicare Advantage, Medicaid, or ACA risk adjustment programs

Desired Skills

  • Demonstrated experience supporting regulatory and operational audits, with a strong understanding of Risk Adjustment programs and applicable CMS and state regulatory requirements
  • Proven ability to lead compliancefocused initiatives through effective project management, organization, and analytical skills
  • Excellent written and verbal communication skills, with the ability to collaborate across crossfunctional teams and communicate complex regulatory requirements clearly to both technical and nontechnical stakeholders

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN or Madison, WI.

The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.  

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.  

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. 

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. 

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