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Risk Adjustment Coder Rn Jobs (NOW HIRING)

Mass Advantage

Manager, Risk Adjustment

Worcester, MA · On-site

Registered Nurse (RN) desired. * CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred. * 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side ...

Greater Good Health

Risk Adjustment Coding Specialist

$80K - $95K/yr

Our innovative model is led by Nurse Practitioners and focused on outcomes, not volume--meaning we ... Certified Risk Adjustment Coder (CRC or equivalent) required * CDI credential preferred (CDIP, CCDS ...

BHC ISC

PBO Risk Adjustment Coding

Fort Lauderdale, FL · On-site

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 ...

Bannerhealth

Risk Adjustment Coding Reviewer

This position requires a credential such as Registered Health Information Administrator (RHIA ... Hold the Certified Risk Adjustment Coder (CRC) credential or similar specialty credential.

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How much do risk adjustment coder rn jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for risk adjustment coder rn in the United States is $27.49, according to ZipRecruiter salary data. Most workers in this role earn between $18.99 and $34.62 per hour, depending on experience, location, and employer.

What is a risk adjustment coder RN?

Risk Adjustment Coder RNs are registered nurses who specialize in reviewing and coding medical records to ensure accurate documentation for risk adjustment purposes. They analyze patient charts to identify diagnoses and conditions, assigning appropriate codes that impact healthcare reimbursement and quality reporting. Their work helps healthcare organizations comply with regulations and receive proper compensation based on patient complexity. These professionals combine clinical knowledge with coding expertise to support accurate risk adjustment data.

What skills and qualifications are needed to be a risk adjustment coder RN?

To thrive as a Risk Adjustment Coder RN, you need a strong background in clinical nursing, detailed knowledge of ICD-10-CM coding, and understanding of risk adjustment models, usually validated by an RN license and medical coding certification (such as CRC or CPC). Familiarity with electronic health record (EHR) systems, coding software, and regulatory guidelines like CMS-HCC is essential. Strong analytical skills, attention to detail, and effective communication help coders accurately interpret clinical documentation and collaborate with healthcare teams. These skills ensure precise coding, optimized reimbursement, and compliance with healthcare regulations.

What are common challenges faced by risk adjustment coder RNs, and how can they be managed?

Risk Adjustment Coder RNs often encounter challenges such as keeping up with frequently updated coding guidelines, accurately translating complex clinical documentation into appropriate codes, and ensuring compliance with regulatory standards. To manage these challenges, it is helpful to participate in ongoing education, leverage coding resources and software tools, and collaborate closely with clinical staff to clarify documentation. Developing strong attention to detail and communication skills also contributes to accuracy and efficiency in the role.

What are popular job titles related to Risk Adjustment Coder Rn jobs?

For Risk Adjustment Coder Rn jobs, the most frequently searched job titles are:

Infographic showing various Risk Adjustment Coder Rn job openings in the United States as of June 2026, with employment types broken down into 90% Full Time, 9% Part Time, and 1% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $57,182 per year, or $27.5 per hour.

Manager, Risk Adjustment

Worcester, MA • On-site

Mass Advantage
Health Care and Social Assistance • 51 - 200 employees
Learn more about Mass Advantageexternal

Full-time

Re-posted 26 days ago

Key responsibilities

  • Oversee the strategy, execution, and performance of Medicare risk adjustment programs, including prospective and retrospective activities.

  • Lead RADV audit readiness, response, and compliance activities, including medical record retrieval and validation.

  • Build and maintain analytics dashboards, KPIs, and reporting to monitor risk score accuracy, coding yield, and program ROI.

Job description

Description

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients' needs in mind.


We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.


Essential Duties and Responsibilities:

Program Strategy & Execution

  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance

  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support

  • Build and maintain the RA analytics layer - dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership

  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed. 

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.


Requirements

  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired. 
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the  V24-V28  transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).


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