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Risk Adjustment Coder Jobs in California (NOW HIRING)

Medix

Risk Adjustment Director

Scotts Valley, CA · On-site

$96.15 - $120.19/hr

Job Summary Our client is seeking a skilled Risk Adjustment Director to serve as the executive ... Skills * Technical proficiency in data analytical tools and coding methodologies. * Strong ...

NORTHEAST COMMUNITY CLINIC

HCC Coder

Alhambra, CA

$34 - $39/hr

Attend weekly meetings and present HCC Risk Adjustment Coding Department feedback, including data analysis, summary details; provide work flows and worksheets as necessary. * Attend Coding and ...

NORTHEAST COMMUNITY CLINIC

HCC Coder

Alhambra, CA · On-site

$34 - $39/hr

Attend weekly meetings and present HCC Risk Adjustment Coding Department feedback, including data analysis, summary details; provide work flows and worksheets as necessary. * Attend Coding and ...

Northeast Community Clinic

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HCC Coder

Alhambra, CA · On-site

$34 - $39/hr

Attend weekly meetings and present HCC Risk Adjustment Coding Department feedback, including data analysis, summary details; provide work flows and worksheets as necessary. * Attend Coding and ...

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All JobsRisk Adjustment Coder JobsRisk Adjustment Coder Jobs in California

Risk Adjustment Coder information

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$27

$42

How much do risk adjustment coder jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for risk adjustment coder in California is $27.13, according to ZipRecruiter salary data. Most workers in this role earn between $18.75 and $34.18 per hour, depending on experience, location, and employer.

What is a risk adjustment coder?

Risk Adjustment Coders are healthcare professionals who review and analyze patient medical records to ensure accurate coding of diagnoses and procedures for risk adjustment purposes. Their work is crucial for health plans and providers, as it affects reimbursement rates and compliance with government programs like Medicare Advantage and the Affordable Care Act. These coders use specialized knowledge of coding systems, such as ICD-10, to assign appropriate codes that reflect patients’ health status and help organizations receive proper funding for patient care.

What are the key skills and qualifications needed to thrive as a risk adjustment coder, and why are they important?

To thrive as a Risk Adjustment Coder, you need a solid understanding of medical coding (especially ICD-10-CM), healthcare regulations, and risk adjustment methodologies, typically supported by certifications like CRC or CPC. Proficiency with coding software, electronic health records (EHR) systems, and auditing tools is essential. Attention to detail, analytical thinking, and strong organizational skills set top performers apart in this role. These competencies ensure accurate coding, compliance, and optimal reimbursement for healthcare organizations.

What are some common challenges faced by risk adjustment coders, and how can they be overcome?

Risk Adjustment Coders often encounter challenges such as interpreting complex medical documentation and ensuring accurate code assignment to reflect patient risk profiles. Keeping up with frequent updates to coding guidelines and payer requirements can also be demanding. To overcome these challenges, coders should engage in continuous education, actively participate in team discussions to clarify ambiguities, and utilize available coding resources or auditing tools. Strong communication with providers and attention to detail are key to maintaining compliance and high-quality coding standards.

What is the difference between Risk Adjustment Coder vs Medical Coder?

AspectRisk Adjustment CoderMedical Coder
CertificationsCPR, RHIT, CCS, or CPC often preferredCCS, CPC, or CPC-H
Work EnvironmentHealthcare facilities, insurance companies, remoteHospitals, clinics, physician offices
Industry UsageHealth plans, risk adjustment programsGeneral medical billing and coding

Both Risk Adjustment Coders and Medical Coders require similar certifications and work in healthcare settings. However, Risk Adjustment Coders focus on coding for risk adjustment models used by insurance companies, while Medical Coders handle broader medical billing and coding tasks. Understanding these differences helps professionals choose the right career path and employers.

How much do risk adjustment coders make in the US?

Risk adjustment coders in the US typically earn between $50,000 and $75,000 annually, depending on experience, certification, and location. Experienced coders with certifications like CPC or CCS may earn higher salaries, especially in healthcare hubs or with specialized skills in coding software and compliance.

How to become a risk adjustment coder?

To become a risk adjustment coder, individuals typically need a high school diploma or equivalent, followed by specialized training in medical coding and risk adjustment principles. Certification through organizations like the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) is often required or preferred, and proficiency with coding tools and medical record review is essential.

Is risk adjustment coding a good career?

Risk adjustment coding is a growing field within healthcare that involves reviewing medical records and assigning codes to accurately reflect patient health status for insurance purposes. It requires knowledge of medical terminology, coding systems like ICD-10, and often certification such as CPC, making it a stable career with opportunities for advancement and specialization.

What are the most commonly searched types of Risk Adjustment Coder jobs in California?

The most popular types of Risk Adjustment Coder jobs in California are:

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

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

What job categories do people searching Risk Adjustment Coder jobs in California look for?

The top searched job categories for Risk Adjustment Coder jobs in California are:

What cities in California are hiring for Risk Adjustment Coder jobs?

Cities in California with the most Risk Adjustment Coder job openings:

Risk Adjustment Coder jobs near you
Infographic showing various Risk Adjustment Coder job openings in California as of August 2026, with employment types broken down into 74% Full Time, 15% Part Time, and 11% Contract. Highlights an 77% In-person, and 23% Remote job distribution, with an average salary of $56,433 per year, or $27.1 per hour.

Risk Adjustment Compliance Specialist, Principal

Oakland, CA • On-site

Blue Shield of California
Insurance Services • 5 - 10K employees

8.3

Company rating: 8.3 out of 10

Based on 50 frontline employees who took The Breakroom Quiz

132nd of 315 rated insurance

Good employer

Paid breaks

Recommended by parents

Learn more about Blue Shield of Californiaexternal

$148K - $223K/yr

Full-time

Re-posted 10 days ago

Job description


Your Role
The Risk Adjustment Compliance Specialist, Principal is responsible for ensuring organizational compliance with laws related to Risk Adjustment across our Marketplace (ACA), Medicaid and Medicare Advantage lines of business. This role involves auditing, monitoring, and evaluating risk adjustment processes, identifying areas of non-compliance, and recommending corrective actions. The Principal collaborates with internal teams and external partners to maintain the integrity of risk adjustment data and supports the development and implementation of compliance programs.
Responsibilities
Your Work
In this role, you will:
  • Conduct regular audits and reviews of risk adjustment data submissions to ensure compliance with regulatory requirements (e.g., CMS, OIG, HHS).
  • Monitor changes in risk adjustment guidelines, policies, and regulations, and communicate updates to relevant stakeholders.
  • Analyze risk adjustment processes and workflows to identify gaps, inefficiencies, or areas of non-compliance.
  • Prepare reports and presentations summarizing audit findings, compliance risks, and recommendations for improvement.
  • Collaborate with coding, clinical, and data management teams to ensure accurate and complete documentation for risk adjustment purposes.
  • Assist in the development and implementation of training programs related to risk adjustment compliance for staff and providers.
  • Support regulatory reporting and respond to compliance inquiries from internal and external auditors.
  • Maintain documentation of compliance activities and findings in accordance with organizational policies.
  • Participate in Risk Adjustment projects and initiatives, providing compliance expertise and guidance.
  • Strategic thought partner to ensure Risk Adjustment programs are in line with Blue Shield of California strategic goals.
  • Build strategic internal and external relationships that support the goals of the teams.
  • Participate in the development and execution of corrective action plans to address identified compliance issues.
  • Participates in the identification and assessment of potential compliance risks within risk adjustment processes and contributes to mitigation strategies.

Qualifications
Your Knowledge and Experience
  • Requires a college degree or equivalent experience. A degree in health care administration, business, public health, or related field is highly preferred
  • Requires a certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent credential
  • Requires 10 years of relevant experience in Risk Adjustment, Healthcare Compliance, Medical Coding, or related area
  • Requires strong knowledge of ICD-10-CM coding, HCC Risk Adjustment models (CMS-HCC and HHS-HCC), regulatory requirements, RADV audit documentation standards, and compliance standards
  • Requires experience with data analysis, auditing, and reporting in a healthcare environment
  • Requires excellent written and verbal communication skills, with the ability to convey complex information clearly
  • Requires one to be detail-oriented, analytical, and able to manage multiple priorities in a fast-paced setting
  • Requires proficiency in Microsoft Office Suite and relevant healthcare software applications
  • Experience with ACA Marketplace (HHS-HCC) and/or Medi-Cal/Medicaid Managed Care Risk Adjustment programs is highly preferred
  • Certification in Healthcare Compliance (CHC) is preferred
    #LI-CS1

About the Team
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:
  • Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
  • Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
  • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
  • For most teams, this means coming into the office two days per week.
  • Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
  • For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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