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Remote Medicare Risk Adjustment Auditor Jobs (NOW HIRING)

Vertek Staffing

HCC Risk Adjustment Coder

Franklin, TN · Remote

$18 - $24/hr

HCC / Risk Adjustment Coder - Remote Risk Adjustment / HCC Coding Experience Required Required ... Experience with Medicare Advantage populations * Experience with value-based care programs

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Quality Assurance Coder & Auditor - HCC Coding

OR · Remote

$48.49/hr

... in a remote environment. Preferred Experience * Medicare Advantage experience * Risk Adjustment ... Coding compliance auditing * Provider education * Clinical Documentation Improvement (CDI) * CMS ...

Datavant

Auditor, HCC Risk Adjustment Coding

$29 - $32/hr

... for risk adjustment and reimbursement purposes. You will play a critical role in translating ... Excellent written and verbal communication skills, ability to work in a remote environment and time ...

Datavant

Auditor, HCC Risk Adjustment Coding

Dallas, TX · Remote

$29 - $32/hr

... for risk adjustment and reimbursement purposes. You will play a critical role in translating ... Excellent written and verbal communication skills, ability to work in a remote environment and time ...

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Remote Medicare Risk Adjustment Auditor information

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$10

$19

$46

How much do remote medicare risk adjustment auditor jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for remote medicare risk adjustment auditor in the United States is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $14.42 and $19.23 per hour, depending on experience, location, and employer.

What is a remote Medicare risk adjustment auditor?

A Remote Medicare Risk Adjustment Auditor is a professional who reviews medical records and other documentation to ensure accurate coding and reporting of diagnoses for Medicare Advantage plans. Their primary role is to verify that healthcare providers have properly documented patient conditions that affect risk adjustment payments from Medicare. By working remotely, these auditors use secure digital systems to access records and ensure compliance with CMS guidelines, helping healthcare organizations maximize appropriate reimbursement and minimize compliance risks.

What skills and qualifications are needed to be a remote Medicare risk adjustment auditor?

To thrive as a Remote Medicare Risk Adjustment Auditor, you need a strong background in medical coding, healthcare regulations, and risk adjustment methodologies, typically supported by a coding certification such as CPC, CRC, or CCS-P. Familiarity with coding software, electronic health record (EHR) systems, and audit tools is essential for accurate data review and reporting. Attention to detail, critical thinking, and strong written communication are important soft skills for this role. These skills ensure accurate risk assessment, compliance with Medicare guidelines, and maximized reimbursement for healthcare organizations.

What are the most common challenges faced by remote Medicare risk adjustment auditors, and how can they be overcome?

Remote Medicare Risk Adjustment Auditors often face challenges such as staying updated on changing CMS guidelines, accurately interpreting complex medical records, and maintaining productivity while working independently. To overcome these, auditors should regularly participate in professional development and training, utilize reliable audit tools and resources, and establish strong communication with their team and supervisors. Building a structured daily routine and fostering connections with peers through virtual meetings can also help maintain focus and support high-quality work.

What are popular job titles related to Remote Medicare Risk Adjustment Auditor jobs?

For Remote Medicare Risk Adjustment Auditor jobs, the most frequently searched job titles are:

Infographic showing various Remote Medicare Risk Adjustment Auditor job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 89% Full Time, 8% Part Time, and 2% Contract. Highlights an 85% Physical, 5% Hybrid, and 10% Remote job distribution, with an average salary of $39,947 per year, or $19.2 per hour.

Risk Adjustment Coding Specialist II - REMOTE (CST/EST)

Houston, TX • On-site, Remote

Astrana Health, Inc.
See more jobs at Astrana Health, Inc.external

$70K - $85K/yr

Full-time

Posted 24 days ago

Job description

Risk Adjustment Coding Specialist II - REMOTE (CST/EST)
Department: Quality - Risk Adjustment
Employment Type: Full Time
Location: 19500 HWY 249, Suite 570 Houston, TX 77070
Reporting To: Liz Francisco
Compensation: $70,000 - $85,000 / year
Description
We are currently seeking a highly motivated Risk Adjustment Coding Specialist to support our Houston market. In this role, you will support risk adjustment efforts by conducting high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers. You'll translate your findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations. Additionally, you'll track and report on key performance metrics-such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
We are seeking candidates who live in CST or EST time zones with strong risk adjustment and provider education experience.
Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
  • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
  • Other duties as assigned

Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC certification, CPC and CRC.
  • At least 3 years of experience in risk adjustment coding and/or billing experience required.
  • At least 1 year of experience with targeted provider education.
  • Reliable transportation/Valid Driver's License/Must be able to travel up to 75% of work time
  • PC skills and experience using Microsoft applications such as Word, Excel, and Outlook
  • Excellent presentation, verbal and written communication skills, and ability to collaborate
  • Must possess the ability to educate and train provider office staff members
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems.

You're great for this role if:
  • Strong billing knowledge and/or Certified Professional Biller (CPB) through APPC
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage
  • Strong PowerPoint and public speaking experience
  • Ability to work independently and collaborate in a team setting
  • Experience with Monday.com
  • Experience collaborating with, educating, and presenting to provider teams in a face-to-face setting

Environmental Job Requirements and Working Conditions
  • The national target pay range for this role is $70,000 - $85,000 per year. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
  • This position is remotely based in the U.S. The home office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.comto request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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