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Remote Medicare Risk Adjustment Jobs in Florida (NOW HIRING)

Phsorg

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY. Hybrid ... Health, Risk Adjustment, Provider Relations, Customer Service, Network Management, and Care ...

Humana

Healthcare Market Finance Lead

Fort Lauderdale, FL · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Analyze market financials, claims data, utilization trends, membership movement, risk adjustment ... Experience in the Medicare Advantage bid process * 3 or more years of experience in Service Fund ...

Humana

Healthcare Market Finance Lead

Fort Lauderdale, FL · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Analyze market financials, claims data, utilization trends, membership movement, risk adjustment ... Experience in the Medicare Advantage bid process * 3 or more years of experience in Service Fund ...

Humana

Healthcare Market Finance Lead

Fort Lauderdale, FL · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Analyze market financials, claims data, utilization trends, membership movement, risk adjustment ... Experience in the Medicare Advantage bid process * 3 or more years of experience in Service Fund ...

Phsorg

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote: Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY. Hybrid ... Strong understanding of claims data, risk adjustment methodologies, and Health Plan financial ...

Lee Health

Coder II - E/M

Cape Coral, FL · On-site +1

$20.50 - $27.85/hr

Remote - FL Department: Coding Work Type: Full Time Shift: Shift 1/8:00:00 AM to 4:30:00 PM Minimum ... Risk Adjustment Coder) • CIC (Certified Inpatient Coder) • CCS (Certified Coding Specialist ...

Lee Health

Coder II - E/M

Cape Coral, FL · Remote

$20.50 - $27.85/hr

Remote - FL Department: Coding Work Type: Full Time Shift: Shift 1/8:00:00AM to 4:30:00PM Minimum ... Risk Adjustment Coder) CIC (Certified Inpatient Coder) CCS (Certified Coding Specialist) RHIT ...

Trinity Health

Manager, Professional Coding

Fort Lauderdale, FL · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... Medicare claims processing manual contents in a multi-facility, integrated health care delivery ... remote work guidelines. Preferred: *Certified E&M Coder (CEMC), and/or Certified Risk Adjustment ...

Trinityhealth

Manager, Professional Coding

Fort Lauderdale, FL · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... Medicare claims processing manual contents in a multi-facility, integrated health care delivery ... remote work guidelines. Preferred: *Certified E&M Coder (CEMC), and/or Certified Risk Adjustment ...

Porter Cares, Inc.

Healthcare Coordinator

Pompano Beach, FL · Remote

$16 - $18/hr

  • Medical

  • Dental

  • Vision

  • PTO

... care, risk adjustment, and member experience. What You'll Do We're seeking dedicated, detail ... Comfortable working in a remote, fast-paced environment with clear communication protocols $16 ...

AdventHealth Corporate

Coding Inpatient Auditor

Orlando, FL · Remote

$25.50 - $29/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Expansive knowledge of Medicare DRGs, APR-DRG, coding guidelines and guidance materials, and ... Possesses knowledge about risk adjustment and publicly reported hospital data. [Required]

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Showing results 21-40

All JobsMedicare Risk Adjustment JobsRemote Medicare Risk Adjustment JobsRemote Medicare Risk Adjustment Jobs in Florida

Remote Medicare Risk Adjustment information

What is the difference between Remote Medicare Risk Adjustment vs Remote Medical Coding Specialist?

AspectRemote Medicare Risk AdjustmentRemote Medical Coding Specialist
CertificationsCPR, CPC, or RAC certifications often preferredCPC, CCS, or CCS-P certifications
Work EnvironmentHealthcare insurance companies, Medicare plansHospitals, clinics, insurance companies
Industry UsagePrimarily in Medicare risk adjustment programsMedical billing and coding across various healthcare settings

Remote Medicare Risk Adjustment and Remote Medical Coding Specialist roles share certifications and healthcare industry usage but differ in focus. Medicare Risk Adjustment involves analyzing patient data to optimize Medicare plan reimbursements, while Medical Coding Specialists translate medical records into billing codes. Both roles require healthcare knowledge but serve distinct functions within the healthcare revenue cycle.

What are the most commonly searched types of Medicare Risk Adjustment jobs in Florida?

The most popular types of Medicare Risk Adjustment jobs in Florida are:

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

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

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The top searched job categories for Remote Medicare Risk Adjustment jobs in Florida are:

What cities in Florida are hiring for Remote Medicare Risk Adjustment jobs?

Cities in Florida with the most Remote Medicare Risk Adjustment job openings:

Remote Medicare Risk Adjustment jobs near you

Director, Actuarial Services (Tampa)

Avalon Administrative Services LLC

Tampa, FL • On-site, Remote

Part-time

Posted 2 days ago

New

Job description

About Avalon Healthcare Solutions:

Avalon Healthcare Solutions is the nation’s leader in diagnostic intelligence, uniquely focused on transforming the role of diagnostic testing across the healthcare ecosystem. Our proprietary Diagnostic Insights Platform delivers evidence-based policies, curated lab networks, and real-time analytics that simplify complex diagnostics, accelerate innovation adoption, and optimize diagnostic investments.

Supporting over 30 health plans and 100 million members nationwide, Avalon partners with payers and providers to ensure diagnostic testing is performed appropriately, efficiently, and at the right time. Our flexible solutions span routine and genetic testing management, automated adherence, and end-to-end diagnostics support—driving measurable value, reduced waste, and improved clinical outcomes.

With unmatched scientific rigor, deep clinical expertise, and a performance-based model, Avalon is redefining how diagnostics power personalized care and healthcare value. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.

For more information about Avalon, please visit www.avalonhcs.com

Avalon Healthcare Solutions is an Equal Opportunity Employer - Vet/Disability.

This position description is subject to change at any time. As determined by the company based upon business needs, an employee in this position may be required to perform duties and take responsibility for work other than as described in this document.

About the Director, Actuarial Services Position:

The Director, Actuarial Services is responsible for leading the organization's actuarial and healthcare analytics functions in support of strategic, financial, and operational objectives. This role directs the development and maintenance of actuarial models, financial forecasts, reserving methodologies, and risk analyses that support business performance and informed decision-making. Leveraging deep actuarial expertise and healthcare industry knowledge, the Director evaluates emerging trends, utilization patterns, medical cost drivers, and financial risks to provide actionable insights and recommendations.  

The Director, Actuarial Services partners closely with executive leadership and cross-functional stakeholders, including Finance, Health Analytics, Network Management, and Product teams, to support pricing strategies, financial forecasting, risk adjustment initiatives, and regulatory compliance. This position is responsible for communicating actuarial findings, financial risk exposure, and strategic recommendations to leadership while driving continuous improvement of actuarial methodologies, tools, data infrastructure, and reporting capabilities. Through the application of advanced analytics and actuarial principles, the Director supports organizational performance, financial sustainability, and data-driven decision-making.

This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.

Director, Actuarial Services – Essential Functions and Responsibilities:

  • Direct the development and maintenance of actuarial models for all lines of businesses and products
  • Monitor program performance, researching reasons for variances and providing/implementing actionable plans
  • Oversee medical cost trend analysis, utilization reviews, and per-member-per-month (PMPM) projections
  • Own the reserving process, including incurred but not reported (IBNR) liability estimates, claims development triangles, and variance analyses
  • Ensure actuarial compliance with state and federal regulatory requirements
  • Partner with finance, health analytics, network management, and product teams to support pricing strategy and financial forecasting
  • Serve as the primary actuarial liaison with internal and external auditors
  • Direct the development of risk adjustment strategies and analytics
  • Provide executive leadership with clear, concise communication of actuarial findings, financial risk exposure, and strategic recommendations
  • Drive continuous improvement of actuarial models, tools, data infrastructure, and team workflows
  • Monitor industry trends, regulatory changes, and emerging healthcare cost drivers and communicate implications to leadership
  • Lead ad hoc analyses and deep dives as required.

    • Director, Actuarial Services – Minimum Qualifications:

  • Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related quantitative field
  • Associate of the Society of Actuaries (ASA) designation is required at minimum
  • Member in good standing with the American Academy of Actuaries (MAAA) required
  • 5+ years of actuarial experience, with at least 5 years in a health plan or managed care setting
  • Demonstrated expertise in healthcare actuarial pricing, reserving, or risk adjustment
  • Strong proficiency in actuarial and analytical tools (e.g., Excel/VBA, Tableau, SAS, R, Python, or similar)
  • Deep understanding of ACA regulations, CMS programs (Medicare Advantage, Medicaid)
  • Exceptional communication and presentation skills with the ability to convey complex actuarial concepts to non-actuarial executives and board members
  • Understanding of medical coding systems (ICD-10, CPT, HCPCS, DRG)
  • Strong analytical, critical thinking, and problem-solving skills
  • Excellent written and verbal communication skills

    • Director, Actuarial Services – Preferred Qualifications:

  • 10+ years of actuarial experience in health insurance, managed care environment
  • Experience with risk adjustment and risk transfer
  • Exposure to predictive modeling, machine learning applications in actuarial contexts, or health risk scoring
  • Experience working with large-scale data platforms (Snowflake, Databricks, AWS)
  • Experience with Tableau, Python or R for statistical analysis
  • Knowledge of value-based care models (ACOs, PCMH, bundled payments)
  • Understanding of HIPAA regulations and healthcare data governance practices

    • PI5017766a9212-38003-41276692

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