Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...
Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness ... High School or Equivalent Experience: 2-5 years of risk adjustment coding E/M procedures and ...
Director Risk Adjustment - Remote
$130K - $150K/yr
Director of Risk Adjustment About IKS Health For more information, visit: www.ikshealth.com IKS ... Expert-level understanding of the end-to-end CMS-HCC Medicare risk coding model, including ...
Director Risk Adjustment - Remote
$130K - $150K/yr
Director of Risk Adjustment About IKS Health For more information, visit: www.ikshealth.com IKS ... Expert-level understanding of the end-to-end CMS-HCC Medicare risk coding model, including ...
Remote Risk Adjustment Coding Auditor
Saint Paul, MN · Remote
$32 - $37/hr
Working knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models * Experience communicating coding findings and audit outcomes to stakeholders * Intermediate proficiency with ...
Quick apply
Remote Risk Adjustment Coding Auditor
Saint Paul, MN · Remote
$32 - $37/hr
Working knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models * Experience communicating coding findings and audit outcomes to stakeholders * Intermediate proficiency with ...
Remote Risk Adjustment Coding Auditor
Saint Paul, MN · Remote
$32 - $37/hr
Working knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models * Experience communicating coding findings and audit outcomes to stakeholders * Intermediate proficiency with ...
Remote Risk Adjustment Coding Auditor
Saint Paul, MN · Remote
$32 - $37/hr
Working knowledge of Medicare, ACA Commercial, and Medicaid risk adjustment models * Experience communicating coding findings and audit outcomes to stakeholders * Intermediate proficiency with ...
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... Education: High School or Equivalent Experience: 2-5 years of risk adjustment coding, E/M ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... Education: High School or Equivalent Experience: 2-5 years of risk adjustment coding, E/M ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... High School Experience: 2-5 years of risk adjustment coding, E/M, procedures and diagnosis ...
Review and audit documentation for appropriate capture of CAT II coding, Medicare Annual Wellness ... High School Experience: 2-5 years of risk adjustment coding, E/M, procedures and diagnosis ...
Utilize risk adjustment reports to prioritize chart reviews, provider education, and documentation improvement efforts. * Promote Medicare Annual Wellness Visits to support preventive care ...
Utilize risk adjustment reports to prioritize chart reviews, provider education, and documentation improvement efforts. * Promote Medicare Annual Wellness Visits to support preventive care ...
Senior Manager, Risk Adjustment
Pasadena, CA · On-site
$100K - $150K/yr
The Sr. Risk Adjustment Manager is responsible for leading and optimizing risk adjustment ... V28), RxHCC methodology for Medicare Part D, and HHS-HCC annual model recalibrations, including ...
Quick apply
Senior Manager, Risk Adjustment
Pasadena, CA · On-site
$100K - $150K/yr
The Sr. Risk Adjustment Manager is responsible for leading and optimizing risk adjustment ... V28), RxHCC methodology for Medicare Part D, and HHS-HCC annual model recalibrations, including ...
Utilize risk adjustment reports to prioritize chart reviews, provider education, and documentation improvement efforts. * Promote Medicare Annual Wellness Visits to support preventive care ...
Utilize risk adjustment reports to prioritize chart reviews, provider education, and documentation improvement efforts. * Promote Medicare Annual Wellness Visits to support preventive care ...
Utilize risk adjustment reports to prioritize chart reviews, provider education, and documentation improvement efforts. * Promote Medicare Annual Wellness Visits to support preventive care ...
Utilize risk adjustment reports to prioritize chart reviews, provider education, and documentation improvement efforts. * Promote Medicare Annual Wellness Visits to support preventive care ...
Risk Adjustment Analyst
Doral, FL · On-site
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
Risk Adjustment Analyst
Doral, FL · On-site
ACA, Medicare, ACO REACH, MSSP, and Medicaid. The Risk Adjustment and Quality Analyst will be responsible for working both independently and collaboratively between multiple departments such as ...
Strong understanding of Medicare Advantage and ACA risk adjustment models (CMS-HCC and HHS-HCC) and RADV analytics. * Experience managing vendors and holding performance accountability. * Proven ...
Strong understanding of Medicare Advantage and ACA risk adjustment models (CMS-HCC and HHS-HCC) and RADV analytics. * Experience managing vendors and holding performance accountability. * Proven ...
Risk Adjustment - Risk Adjustment Coding Auditor
Tulsa, OK · On-site
$23.50 - $27/hr
The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation ... in Medicare Advantage and ACA preferred. • Experience with internal audit programs or payer ...
Risk Adjustment - Risk Adjustment Coding Auditor
Tulsa, OK · On-site
$23.50 - $27/hr
The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation ... in Medicare Advantage and ACA preferred. • Experience with internal audit programs or payer ...
Risk Adjustment Specialist
Manhattan, NY · Hybrid
$72K - $82K/yr
Position Overview Risk Adjustment is a growing and critical field within Health Insurance Finance ... Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines ...
Risk Adjustment Specialist
Manhattan, NY · Hybrid
$72K - $82K/yr
Position Overview Risk Adjustment is a growing and critical field within Health Insurance Finance ... Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines ...
Risk Adjustment Specialist
Manhattan, NY · On-site
$72K - $82K/yr
Position Overview Risk Adjustment is a growing and critical field within Health Insurance Finance ... Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines ...
Risk Adjustment Specialist
Manhattan, NY · On-site
$72K - $82K/yr
Position Overview Risk Adjustment is a growing and critical field within Health Insurance Finance ... Medicaid, Medicare and Affordable Care Act/QHP. This includes monitoring submission timelines ...
Risk Adjustment Coding Auditor
Huntington Beach, CA · On-site +1
$28.50 - $32.25/hr
We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112 ... Job Summary The Risk Adjustment Coding Auditor is responsible for conducting retrospective and ...
Risk Adjustment Coding Auditor
Huntington Beach, CA · On-site +1
$28.50 - $32.25/hr
We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112 ... Job Summary The Risk Adjustment Coding Auditor is responsible for conducting retrospective and ...
Risk Adjustment Coding Auditor
Phoenix, AZ · Remote
$32 - $37/hr
Knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models. * Ability to interpret and apply coding policies, regulations, and guidelines. * Experience providing coding education ...
Risk Adjustment Coding Auditor
Phoenix, AZ · Remote
$32 - $37/hr
Knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models. * Ability to interpret and apply coding policies, regulations, and guidelines. * Experience providing coding education ...
Position Summary As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk ...
Position Summary As a Senior Manager, Medicare Compliance - Risk Adjustment, you are responsible for overseeing and maintaining compliance with CMS regulations related to Medicare Advantage Risk ...
Familiarity with Medicare Advantage (preferred) and/or other risk programs, including chart review ... adjustment audits), and designing monitoring/controls. * Experience developing or specifying ...
Familiarity with Medicare Advantage (preferred) and/or other risk programs, including chart review ... adjustment audits), and designing monitoring/controls. * Experience developing or specifying ...
Medicare Risk Adjustment information
See salary details
$12.74 - $15.23
16% of jobs
$15.87 is the 25th percentile. Wages below this are outliers.
$15.23 - $17.72
34% of jobs
$17.72 - $20.21
18% of jobs
$20.21 - $22.71
1% of jobs
$24.02 is the 75th percentile. Wages above this are outliers.
$22.71 - $25.20
10% of jobs
$25.20 - $27.69
4% of jobs
$27.69 - $30.18
3% of jobs
$30.18 - $32.67
2% of jobs
$32.67 - $35.16
9% of jobs
$35.16 - $37.65
0% of jobs
$37.65 - $40.14
2% of jobs
$12
$22
$40
How much do medicare risk adjustment jobs pay per hour?
As of Aug 12, 2026, the average hourly pay for medicare risk adjustment in the United States is $22.42, according to ZipRecruiter salary data. Most workers in this role earn between $16.11 and $27.16 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 cities are hiring for Medicare Risk Adjustment jobs? Cities with the most Medicare Risk Adjustment job openings:
What are the most commonly searched types of Medicare Risk Adjustment jobs? The most popular types of Medicare Risk Adjustment jobs are:
What states have the most Medicare Risk Adjustment jobs? States with the most job openings for Medicare Risk Adjustment jobs include:
What job categories do people searching Medicare Risk Adjustment jobs look for? The top searched job categories for Medicare Risk Adjustment jobs are:
Full-time
Posted 24 days ago
Job description
Broward Health Corporate ISC
Shift: Shift 1
FTE: 1.000000
Requisition: 31881
Summary: Ensures procedures E&M and diagnoses are coded as documented in the medical records according to ICD-10-CM CPT-4 and HCPCS in an effort to maintain accurate coding and obtain reimbursement all within the professional coding guidelines Centers for Medicare and Medicaid (CMS) guidelines and Broward Health policies. Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness Visits Medicare Risk HRA/HCC Assessment forms Medicare Advantage plans suspect HCC condition forms prior to submission to the payer.
Education: High School or Equivalent
Experience: 2-5 years of risk adjustment coding E/M procedures and diagnosis experience required
Credentials: Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC). Proficient in Microsoft Word Excel and PowerPoint. Competent in Electronic Health Records NextGen and Cerner experience preferred.
Visit us online at www.BrowardHealth.org or contact Talent Acquisition
*Bonus Exclusions may apply in accordance with policy HR-004-026
Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race color national origin gender gender identity or gender expression pregnancy sexual orientation religion age disability military status genetic information or any other characteristic protected under applicable federal or state law.
At Broward Health the dedication and contributions of veterans are valued. Supporting the military community and giving back to those who served is a priority. Broward Health is proud to offer veteran's preference in the hiring process to eligible veterans and other individuals as defined by applicable law.
Shift: Shift 1
FTE: 1.000000
Requisition: 31881
Summary: Ensures procedures E&M and diagnoses are coded as documented in the medical records according to ICD-10-CM CPT-4 and HCPCS in an effort to maintain accurate coding and obtain reimbursement all within the professional coding guidelines Centers for Medicare and Medicaid (CMS) guidelines and Broward Health policies. Review and audit documentation for appropriate capture of CAT II coding Medicare Annual Wellness Visits Medicare Risk HRA/HCC Assessment forms Medicare Advantage plans suspect HCC condition forms prior to submission to the payer.
Education: High School or Equivalent
Experience: 2-5 years of risk adjustment coding E/M procedures and diagnosis experience required
Credentials: Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC). Proficient in Microsoft Word Excel and PowerPoint. Competent in Electronic Health Records NextGen and Cerner experience preferred.
Visit us online at www.BrowardHealth.org or contact Talent Acquisition
*Bonus Exclusions may apply in accordance with policy HR-004-026
Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race color national origin gender gender identity or gender expression pregnancy sexual orientation religion age disability military status genetic information or any other characteristic protected under applicable federal or state law.
At Broward Health the dedication and contributions of veterans are valued. Supporting the military community and giving back to those who served is a priority. Broward Health is proud to offer veteran's preference in the hiring process to eligible veterans and other individuals as defined by applicable law.