This role requires deep VBC domain expertise, specifically in Medicare risk adjustment economics, medical claims expense drivers, and membership cohort dynamics. The ideal candidate understands how ...
This role requires deep VBC domain expertise, specifically in Medicare risk adjustment economics, medical claims expense drivers, and membership cohort dynamics. The ideal candidate understands how ...
This role requires deep VBC domain expertise, specifically in Medicare risk adjustment economics, medical claims expense drivers, and membership cohort dynamics. The ideal candidate understands how ...
This role requires deep VBC domain expertise, specifically in Medicare risk adjustment economics, medical claims expense drivers, and membership cohort dynamics. The ideal candidate understands how ...
Specialist, Health Plan Provider Engagement
$42K - $48K/yr
Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item ...
Specialist, Health Plan Provider Engagement
$42K - $48K/yr
Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item ...
Specialist, Health Plan Provider Engagement
Seattle, WA · On-site
$83K - $101K/yr
Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item ...
Specialist, Health Plan Provider Engagement
Seattle, WA · On-site
$83K - $101K/yr
Drives provider partner coaching and collaboration to improve Medicaid, Medicare and Marketplace quality performance and risk adjustment accuracy through consistent provider meetings, action item ...
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 ...
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Snohomish County, Washington. This unique opportunity ...
Quick apply
Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Snohomish County, Washington. This unique opportunity ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Snohomish County, Washington. This unique ...
Description Hueman is actively hiring Nurse Practitioners to complete in-home Health Risk Assessments (HRAs) for Medicare and Medicaid members in and around Snohomish County, Washington. This unique ...
Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most ... risk adjustment (coding quality). This role is critical to developing deep relationships with ...
Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most ... risk adjustment (coding quality). This role is critical to developing deep relationships with ...
Case Manager I (MSW/RN) Medicare/DSNP
Seattle, WA · On-site +1
$37.96 - $58.84/hr
Uses the assessment information to assign the appropriate risk and complexity level, and create and ... adjustments as indicated. * Continuously evaluate members' progress towards goals, identify ...
Case Manager I (MSW/RN) Medicare/DSNP
Seattle, WA · On-site +1
$37.96 - $58.84/hr
Uses the assessment information to assign the appropriate risk and complexity level, and create and ... adjustments as indicated. * Continuously evaluate members' progress towards goals, identify ...
Uses the assessment information to assign the appropriate risk and complexity level, and create and ... adjustments as indicated. * Continuously evaluate members' progress towards goals, identify ...
Quick apply
Uses the assessment information to assign the appropriate risk and complexity level, and create and ... adjustments as indicated. * Continuously evaluate members' progress towards goals, identify ...
Case Manager I (MSW/RN) Medicare/DSNP
Seattle, WA · Remote
$78K - $122K/yr
Uses the assessment information to assign the appropriate risk and complexity level, and create and ... adjustments as indicated. * Continuously evaluate members' progress towards goals, identify ...
Case Manager I (MSW/RN) Medicare/DSNP
Seattle, WA · Remote
$78K - $122K/yr
Uses the assessment information to assign the appropriate risk and complexity level, and create and ... adjustments as indicated. * Continuously evaluate members' progress towards goals, identify ...
Authorization & Benefits Specialist
Issaquah, WA · On-site
$20.75 - $27.75/hr
Ensure appropriate forms are used when requesting adjustments, insurance transfers or other ... Medicare experience strongly preferred. * Insurance experience and knowledge in commercial, work ...
Authorization & Benefits Specialist
Issaquah, WA · On-site
$20.75 - $27.75/hr
Ensure appropriate forms are used when requesting adjustments, insurance transfers or other ... Medicare experience strongly preferred. * Insurance experience and knowledge in commercial, work ...
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Authorization & Benefits Specialist
Issaquah, WA · On-site
$19.97 - $31.95/hr
Ensure appropriate forms are used when requesting adjustments, insurance transfers or other ... Medicare experience strongly preferred. * Insurance experience and knowledge in commercial, work ...
Authorization & Benefits Specialist
Issaquah, WA · On-site
$19.97 - $31.95/hr
Ensure appropriate forms are used when requesting adjustments, insurance transfers or other ... Medicare experience strongly preferred. * Insurance experience and knowledge in commercial, work ...
Care Coordination Master Social Worker
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Care Coordination Master Social Worker
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Care Coordination Master Social Worker
Silverdale, WA · On-site
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Care Coordination Master Social Worker
Silverdale, WA · On-site
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Care Coordination Master Social Worker
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Care Coordination Master Social Worker
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Care Coordination Master Social Worker
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Care Coordination Master Social Worker
$38.21 - $61.85/hr
... risk management identification and referral. * Psychosocial management: crisis intervention ... CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of ...
Medicare Risk Adjustment information
See Seattle, WA salary details
$14.50 - $17.33
16% of jobs
$18.06 is the 25th percentile. Wages below this are outliers.
$17.33 - $20.17
34% of jobs
$20.17 - $23
18% of jobs
$23 - $25.84
1% of jobs
$27.34 is the 75th percentile. Wages above this are outliers.
$25.84 - $28.67
10% of jobs
$28.67 - $31.51
4% of jobs
$31.51 - $34.34
3% of jobs
$34.34 - $37.18
2% of jobs
$37.18 - $40.01
9% of jobs
$40.01 - $42.85
0% of jobs
$42.85 - $45.68
2% of jobs
$14
$25
$45
How much do medicare risk adjustment jobs pay per hour?
As of Aug 12, 2026, the average hourly pay for medicare risk adjustment in Seattle, WA is $25.51, according to ZipRecruiter salary data. Most workers in this role earn between $18.32 and $30.91 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?
| 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 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 popular job titles related to Medicare Risk Adjustment jobs in Seattle, WA? For Medicare Risk Adjustment jobs in Seattle, WA, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment jobs in Seattle, WA look for? The top searched job categories for Medicare Risk Adjustment jobs in Seattle, WA are:
Full-time
Posted 29 days ago
Amazon rating
7.4
Based on 7,082 frontline employees who took The Breakroom Quiz
6th of 39 rated national retailers
Job description
Amazon Health Services is seeking a Manager, Business Analysis to lead our VBC performance operations analytics team within Medicare Population Health Programs. This leader will own the business reporting cadence, including WBRs, MBRs, and QBRs, and manage a team of business analysts who deliver the insights, forecasts, and models that enable leadership to make informed decisions about our value-based care business.
This role requires deep VBC domain expertise, specifically in Medicare risk adjustment economics, medical claims expense drivers, and membership cohort dynamics. The ideal candidate understands how to translate complex VBC data into clear narratives that drive action, and can build forecasting models that help leadership anticipate performance trajectories across our ACO and MA portfolios.
This person partners closely with our BIE / DE teams as the primary consumer and requirements-setter for data products, ensuring the right data is available, accurate, and translated into business meaning.
Key job responsibilities
Business Operations Cadence
- Own the end-to-end WBR, MBR, and QBR process for VBC performance, including narrative development, variance analysis, and action tracking
- Ensure leadership has clear line of sight into MCER trends, RAF performance, membership retention, and cohort-level economics on a recurring cadence
- Drive deep dives when performance deviates from plan, identifying root causes and recommending corrective actions
- Establish and maintain the metrics framework that defines how we measure VBC success
VBC Performance Insights
- Translate risk adjustment data into actionable insights, including RAF completeness trends, coding opportunity identification, and revenue impact quantification
- Analyze MCE drivers across categories (inpatient, specialty, pharmacy, post-acute) to surface intervention opportunities
- Develop membership analytics including engagement scoring, retention drivers, and cohort economic trajectories
- Quantify the impact of operational programs (care coordination, readmission prevention, specialty network optimization) on financial outcomes
Team Leadership
- Manage and develop a team of business analysts, setting clear expectations for analytical rigor, business acumen, and stakeholder communication
- Build team capabilities in VBC-specific analytics including risk adjustment modeling, claims analysis, and population health measurement
- Establish standards for analytical deliverables, ensuring consistency, accuracy, and actionability
- Create career development paths that grow analysts into VBC domain experts
Cross-Functional Partnership
- Partner with actuary and finance to build maintain membership forecasting models that project cohort growth, attrition, and tenure mix across markets and payers
- Partner with the BIE Manager to define data requirements, validate data quality, and prioritize dashboard and reporting development
- Collaborate with clinical operations, network, and growth teams to ensure analytics support operational decision-making
- Work with finance to align on definitions, methodologies, and reporting standards across VBC financial metrics
- Represent business analytics needs in data architecture and platform planning discussions
About the team
You'll be a key leader on the MPHP team, working at the intersection of clinical operations, technology, and financial performance for One Medical Seniors
The MPHP team supports central strategy, operations and analytics for the One Medical Seniors business line. You will lead a team of 6-7 BAs. This role requires a leader who thrives in ambiguity, brings clarity to complexity, and can align diverse stakeholders around a shared vision.
You'll partner deeply with the MPHP clinical leadership, VBC operations, Product, and BIE/DE teams to drive a top-priority organizational goal: delivering VBC performance and operations insights to better deliver value-based care to our Medicare patients. You'll thrive here if you are energized by high-stakes, high-impact work and are passionate about improving care for Medicare patients at scale.
About Amazon
Sourced by ZipRecruiter
Amazon.com, Inc., commonly known as Amazon, is an American multinational technology company. It was founded by Jeff Bezos in 1994 and initially started as an online marketplace for books. Since then, Amazon has expanded its operations and become one of the largest e-commerce companies in the world. Amazon's primary business is its online retail platform, where customers can purchase a vast array of products, including electronics, clothing, books, home goods, and much more. The company offers a convenient and user-friendly shopping experience, with features such as fast shipping, customer reviews, and personalized recommendations. In addition to its e-commerce platform, Amazon has diversified its business into various other areas. One of its notable ventures is Amazon Web Services (AWS), a comprehensive cloud computing platform that provides services such as storage, compute power, and database management to individuals and businesses. AWS has become a leader in the cloud computing industry, powering many websites and applications worldwide. Amazon has also developed its own consumer electronics, including the popular Amazon Kindle e-reader, Fire tablets, Fire TV streaming devices, and the Alexa-powered Echo smart speakers. The Alexa voice assistant, integrated into these devices, allows users to interact with their devices using voice commands, perform tasks, and access information. Furthermore, Amazon has expanded into media and entertainment. It operates Prime Video, a streaming service that offers a wide range of movies, TV shows, and original content. Amazon Music provides a platform for streaming and purchasing digital music, while Audible offers audiobooks and other audio content. The company's commitment to customer satisfaction and convenience is demonstrated by its membership program, Amazon Prime. Prime members receive various benefits, including free two-day shipping, access to streaming services, exclusive deals, and more.
Industry
It services, book publishers, retail, real estate and computer and electronic product manufacturing
Company size
10,000+ Employees
Headquarters location
Seattle, WA, US