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Medicare Risk Assessment information

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$19

$38

$66

How much do medicare risk assessment jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for medicare risk assessment in California is $38.18, according to ZipRecruiter salary data. Most workers in this role earn between $23.51 and $53.61 per hour, depending on experience, location, and employer.

What is a Medicare Risk Assessment job?

A Medicare Risk Assessment job involves evaluating patients' health conditions to determine risk scores that impact Medicare Advantage plan reimbursements. Professionals in this role collect and analyze medical data, review patient histories, and ensure accurate coding of diagnoses. Their work helps healthcare providers and insurers understand patient risks and deliver appropriate care. Strong knowledge of ICD-10 coding, healthcare regulations, and medical terminology is essential for this role.

What are some common challenges faced in a Medicare Risk Assessment role?

One common challenge in Medicare Risk Assessment is staying up to date with frequently changing Medicare regulations and coding requirements, which directly affect risk scoring and patient documentation. Handling large volumes of patient data while ensuring accuracy and compliance can also be demanding, as errors may impact reimbursement and care outcomes. Collaboration with clinicians, billing teams, and administrators is often necessary to clarify complex cases and ensure complete, compliant documentation. Successfully navigating these challenges requires ongoing learning, keen attention to detail, and effective communication skills.

What are the key skills and qualifications needed to thrive in the Medicare Risk Assessment position, and why are they important?

To thrive in a Medicare Risk Assessment role, you need a strong understanding of healthcare regulations, Medicare guidelines, data analysis, and clinical assessment—often supported by a background in nursing, healthcare administration, or a related field. Proficiency with health risk assessment tools, electronic health records (EHRs), and data management systems is important, and certification such as Certified Risk Adjustment Coder (CRC) can be beneficial. Attention to detail, analytical thinking, and effective communication stand out as key soft skills in this position. These skills are crucial for accurately evaluating patient risk, ensuring compliance, and supporting optimal Medicare plan outcomes.

What are popular job titles related to Medicare Risk Assessment jobs in California? For Medicare Risk Assessment jobs in California, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Assessment jobs in California look for? The top searched job categories for Medicare Risk Assessment jobs in California are:
Medicare Risk Assessment jobs near you
Infographic showing various Medicare Risk Assessment job openings in California as of July 2026, with employment types broken down into 2% As Needed, 79% Full Time, 16% Part Time, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $79,406 per year, or $38.2 per hour.
HEALTH CODER - HCC & RISK ADJUSTMENT

HEALTH CODER - HCC & RISK ADJUSTMENT

North East Medical Services

Burlingame, CA • On-site

$42.79 - $48.75/hr

Other

Posted 10 days ago

Job description

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization's quality outcomes and financial performance.
ESSENTIAL JOB FUNCTIONS:
  • HCC Coding and Risk Adjustment (RA) Program Support
    • Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
    • Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
    • Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
  • Provider Training and Clinical Documentation Improvement (CDI)
  • Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
  • Provide one-on-one and group training to providers and clinical staff to improve documentation quality and accuracy.
  • Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.
  • Data Analysis and Reporting
    • Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
    • Generate reports and dashboards to track coding performance and documentation accuracy.
    • Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.
  • Compliance and Continuous Improvement
    • Stay up to date with changes in coding, risk adjustment, and Medicare regulations.
    • Assist in the development and implementation of internal coding policies and procedures.
    • Participate in quality improvement initiatives related to coding and documentation.
    • Performs other job duties as required by manager/supervisor

  • Education & Certification:
    • BS/BA Degree in Health Science or General Education is required.
    • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification is required.
    • Additional CDI or auditing certifications (CCDS, CDEO, CPMA) are preferred.
  • Experience:
    • Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
    • Experience in provider education, clinical documentation improvement (CDI), and chart audits.
    • Previous experience working in an IPA, managed care organization, or similar setting is strongly preferred.
  • Skills & Competencies:
    • Excellent communication, presentation, and interpersonal skills.
    • Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
    • Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
    • Proficiency in electronic health records (EHR) and coding software.
    • Strong analytical and problem-solving skills.

LANGUAGE:
  • Must be able to fluently speak, read and write English.
  • Fluency in other languages is an asset.

STATUS:
  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This a full-time position.

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