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Remote Medicare Risk Adjustment Jobs in Virginia

Albanymed

Senior Professional Coder

Broadway, VA · Remote

$64K - $97K/yr

Act as an expert for the HCC/Risk adjustment coding. This position is remote but does require onsite education to providers as needed. Essential Duties and Responsibilities * Review, analyze, and ...

Riverside Health System Non-Providers

$53K - $74K/yr

Newport News, VA (not eligible for remote work) Overview The Budget Accountant uses independent ... adjustments, charity and bad debt, the preparation and filing of Medicare and Medicaid annual cost ...

New

Riverside

$53K - $74K/yr

Newport News, VA (not eligible for remote work) Overview The Budget Accountant uses independent ... adjustments, charity and bad debt, the preparation and filing of Medicare and Medicaid annual cost ...

New

Riverside

Compliance Analyst RMG

Newport, VA · Remote

$57K - $78K/yr

... remote work eligible for candidates residing in the following states: FL, GA, ID, KS, KY, MS, NC ... Overview Primary responsibility is to independently perform clinical chart reviews, risk adjustment ...

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

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 Virginia?

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

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

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

What job categories do people searching Remote Medicare Risk Adjustment jobs in Virginia look for?

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

Remote Medicare Risk Adjustment jobs near you
Infographic showing various Remote Medicare Risk Adjustment job openings in Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Sr. Medical Economics Analyst

Arlington, VA • Remote

Ennoble Care
Health Care and Social Assistance • 201 - 500 employees

4.2

Company rating: 4.2 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Learn more about Ennoble Careexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

About Us

Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, "To Care is an Honor." Join Ennoble Care today!

Position Overview 

We are seeking an experienced Sr. Medical Economics Analyst to join our value-based care (VBC) team in our Accountable Care Organization (ACO). This role requires a seasoned professional with 3-5 years of data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes. 

Key Responsibilities 

Risk Assessment & Medicare Analytics 

  • Develop and maintain sophisticated risk-adjusted provider group performance models using CMS-HCC methodology.
  • Analyze VBC performance under various CMS and CMMI total cost-of-care models.
  • Monitor and forecast financial performance across assigned patient populations.
  • Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets, including simulating CMS-HCC risk adjustment. 

Data Management & Analytics 

  • Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
  • Ensure data quality and integrity across all analytical processes. 

Business Intelligence & Reporting 

  • Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
  • Develop executive dashboards and performance metrics aligned with organizational strategic goals.
  • Present findings and recommendations to leadership teams and clinical stakeholders.
  • Support budget planning and financial forecasting processes. 

Regulatory Compliance & Process Improvement 

  • Stay current with evolving CMS and CMMI program requirements and quality measures.
  • Collaborate with revenue cycle and coding teams to optimize documentation and billing accuracy. 
Required Qualifications 

Education & Certification 

  • Bachelor's degree in Data Science, Statistics, Mathematics, Economics, Business Administration or related quantitative field 

Experience Requirements 

  • 3-5 years of data analytics experience, preferably in healthcare or Medicare-focused environments
  • Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models
  • Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs
  • Proven track record analyzing Medicare claims data, specifically CCLF and BCDA datasets
  • In-depth knowledge of healthcare billing processes from both provider and CMS perspectives 

Technical Proficiency 

  • Advanced proficiency in Microsoft Excel (pivot tables, complex formulas, VBA preferred)
  • Strong SQL skills with ability to write complex queries and optimize database performance
  • Experience with Microsoft Azure cloud platform and related analytics tools
  • Proven ability to work with very large datasets (multi-million row files) and combine data from multiple sources
  • Experience integrating EHR data with claims datasets for comprehensive population health analysis 

Core Competencies 

  • Exceptional analytical and problem-solving capabilities
  • Strong business acumen with the ability to translate technical findings into strategic recommendations
  • Excellent written and verbal communication skills for both technical and non-technical audiences
  • Proven team player with a collaborative approach to cross-functional projects
  • Demonstrated capability to understand and respond to evolving business needs 

Location:  Fully Remote (with up to 10% travel) 

This position requires the ability to work with sensitive healthcare information and maintain strict confidentiality in accordance with HIPAA and other applicable regulations. 

Full-time employees qualify for the following benefits:

  • Medical, Dental, Vision and supplementary benefits such as Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity. 
  • Paid Time Off
  • Paid Office Holidays 

All employees qualify for these benefits:

  • Paid Sick Time
  • 401(k) with up to 3% company match
  • Referral Program
  • Payactiv: pay-on-demand. Cash out earned money when and where you need it!

Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) before an offer of employment is extended.

Ennoble Care is an Equal Opportunity Employer, committed to hiring the best team possible, and does not discriminate against protected characteristics including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status. 

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