WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics
Oregon, WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics
Oregon, WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
WI · On-site
$100 - $232/hr
Position Summary Revenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and ...
Lead Director, Risk Adjustment Performance Reporting and Insights
Oregon, WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
Lead Director, Risk Adjustment Performance Reporting and Insights
Oregon, WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
WI · On-site
$100 - $232/hr
Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements. * Experience at a health plan or ...
... risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). Develops educational materials for providers in relation to ...
... risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). Develops educational materials for providers in relation to ...
... risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). Develops educational materials for providers in relation to ...
... risk adjustment data submitted to the Centers for Medicare & Medicaid Services (CMS) and the Department of Health Services (DHS). Develops educational materials for providers in relation to ...
Telehealth Nurse Practitioner
Madison, WI · On-site +1
$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 ...
Telehealth Nurse Practitioner
Madison, WI · On-site +1
$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 ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Experience with the risk adjustment and reimbursement landscape (Medicare Advantage, ACA, Medicaid managed care, HCC coding, RAF optimization, RADV, and documentation/compliance) is strongly ...
Hierarchical Condition Category (HCC) Coding Specialist
Madison, WI · 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
Madison, WI · 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 ...
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.
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.
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
Medical Coding Specialist II - Profee Radiology
Middleton, WI · On-site
$28.21 - $42.32/hr
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
Medical Coding Specialist II - Profee Radiology
Middleton, WI · On-site
$28.21 - $42.32/hr
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
... and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory ... Certified Risk Adjustment Coder (CRC) Upon Hire Required or * Registered Health Information ...
Medicare Risk Adjustment information
See Wisconsin salary details
$12.86 - $15.37
16% of jobs
$16.02 is the 25th percentile. Wages below this are outliers.
$15.37 - $17.89
34% of jobs
$17.89 - $20.40
18% of jobs
$20.40 - $22.92
1% of jobs
$24.25 is the 75th percentile. Wages above this are outliers.
$22.92 - $25.43
10% of jobs
$25.43 - $27.95
4% of jobs
$27.95 - $30.46
3% of jobs
$30.46 - $32.98
2% of jobs
$32.98 - $35.49
9% of jobs
$35.49 - $38.01
0% of jobs
$38.01 - $40.52
2% of jobs
$12
$22
$40
How much do medicare risk adjustment jobs pay per hour?
As of Aug 18, 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 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 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?
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 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 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.
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:
Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics
WI • On-site
$100 - $232/hr
Other
Medical, Dental, Vision, Retirement, PTO
Posted 5 days ago
Job description
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
Position SummaryRevenue Integrity Informatics is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. This role is responsible for driving risk score accuracy and completeness, ensuring regulatory compliance, and delivering actionable data-informed opportunities. The role is highly visible within the enterprise and will be a key contributor to strategic decision-making with senior management.
This role may sit anywhere in the US.
Key ResponsibilitiesRisk Adjustment & Business Performance- Lead enterprise risk adjustment analytics supporting risk score completeness, accuracy, engagement, recapture, and algorithms.
- Leverage claims and clinical data for deep learning into drivers of performance and model impacts.
- Proactively engage with stakeholders on emerging trends, rising risk, and data-driven opportunities
- Oversee the analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.
- Directs the prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.
- Lead the development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.
- Drive innovation through automation, advanced analytics, and emerging technologies that improve efficiency and scalability
- Measure and evaluate intervention effectiveness and overall business impact
- Translate complex analytical findings into practical recommendations that improve operational, clinical, and financial outcomes.
- Partner with technology and data engineering teams to enhance data architecture, automation, and analytics capabilities.
- Partner with executive leadership, market leaders, finance, actuarial, service operations, and clinical teams to support strategic planning and performance improvement efforts.
- Provide executive-level presentations and recommendations that influence organizational strategy and investment decisions.
- Manage data relationships with external vendors and business partners
- Ensure adherence to CMS regulations, data governance policies, and organizational compliance expectations.
- Lead analytical support for compliance reviews and risk adjustment governance activities
- Establish and maintain controls that promote data integrity, auditability, transparency, and accuracy.
- Monitor regulatory and industry changes, assess business impact, and ensure timely implementation of required analytic and reporting enhancements.
- Lead, mentor, and develop a high-performing team of leaders and individual contributors across analytics, informatics, data science, and related disciplines.
- Foster a culture of collaboration, innovation, continuous improvement, and results-oriented execution.
- Champion technical excellence and continuous learning in areas including risk adjustment analytics, AI modeling, SQL, SAS, Python, BigQuery, and similar
- 10+ years of experience in healthcare analytics, informatics, risk adjustment, actuarial, finance, data science, or related disciplines.
- 2+ years of leadership experience (direct reports, team lead).
- Advanced technical proficiency in SQL, SAS, Python, BigQuery, or similar
- Experience with predictive analytics, machine learning, financial modeling, or data science concepts
- Demonstrated ability to influence leadership and deliver measurable business results.
- Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements.
- Experience at a health plan or provider system
- Bachelor's degree or equivalent professional work experience
- Master's degree in Business, Informatics, Analytics, Finance, Statistics, Computer Science, Public Health, Healthcare analytics, Actuarial, Mathematics, Economics, or equivalent combination of advanced education, professional certification, or demonstrated subject matter expertise preferred
The typical pay range for this role is:
$100,000.00 - $231,540.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 09/06/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.