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Risk Adjustment Coder Jobs in Michigan (NOW HIRING)

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Risk Adjustment Coder information

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$13

$23

$37

How much do risk adjustment coder jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for risk adjustment coder in Michigan is $23.96, according to ZipRecruiter salary data. Most workers in this role earn between $16.54 and $30.19 per hour, depending on experience, location, and employer.

What do risk adjustment coders do?

Risk adjustment coders review medical records and assign accurate diagnosis codes to reflect patients' health conditions. Their work helps insurance companies and healthcare organizations assess risk and determine appropriate reimbursements, often using coding systems like ICD-10. Attention to detail and knowledge of coding guidelines are essential for accuracy in this role.

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.

Is HCC coding a good career?

Risk adjustment coders specializing in Hierarchical Condition Category (HCC) coding play a vital role in healthcare reimbursement and risk management. The field offers steady demand, opportunities for certification, and potential for career advancement, especially for those with strong attention to detail and knowledge of medical coding and billing systems.

What are Risk Adjustment Coders?

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.

How to become a risk adjustment coder?

To become a risk adjustment coder, typically one needs a high school diploma or equivalent, followed by completing a coding certification program such as Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC). Experience with medical coding, understanding of healthcare documentation, and proficiency in coding software are also important for this role.

What pays more, CCS or CPC?

As a Risk Adjustment Coder, CPC (Certified Professional Coder) typically offers higher pay than CCS (Certified Coding Specialist) because CPCs are often more versatile and in demand across various healthcare settings. However, salaries can vary based on experience, certification, and geographic location. Both certifications are valuable, but CPCs generally have higher earning potential in the coding field.

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.
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Risk Adjustment Coder jobs near you
Infographic showing various Risk Adjustment Coder job openings in Michigan as of July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $49,839 per year, or $24 per hour.
Risk Adjustment Compliance Coder

Risk Adjustment Compliance Coder

Upper Peninsula Health Plan

Marquette, MI • Remote

$28.86/hr

Full-time

Posted 6 days ago

Job description

DATE: July 20, 2026POSITION:  Risk Adjustment Compliance CoderDEPARTMENT:  Finance-Risk AdjustmentRATE: $28.86 per hour, with potential for additional compensation based on qualifications. POSITION SUMMARY: 
The Risk Adjustment Compliance Coder is responsible for enhancing the accuracy, quality, and integrity of coding data that supports Medicare and Medicaid reimbursement. This role conducts risk adjustment coding audits, performs compliance research, responds to coding inquiries, and serves as a subject matter expert in risk adjustment coding and compliance. The position supports Medicare and Medicaid risk adjustment programs through the development, implementation, and ongoing evaluation of program initiatives. Highly collaborative and operational in nature, this role partners closely with providers and internal stakeholders and requires strong communication, education, and relationship-management skills. This is not a traditional production-focused coding position. 
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
 
2. Collaborates with Risk Adjustment Analyst to develop, implement, and continually refine internal prospective and retrospective chart review programs and related risk adjustment initiatives.
 
3. Follows International Classification of Diseases (ICD)-10 guidelines for Coding and Reporting, Centers for Medicare & Medicaid Services (CMS) risk adjustment guidelines, and demonstrates knowledge of Current Procedural Terminology (CPT) coding. Understands the impact of ICD-10 coding on the CMS Hierarchical Condition Categories (HCC) risk adjustment model, and serves as the subject matter expert for risk adjustment activities.
 
4. Supports risk adjustment compliance and program integrity activities, including RADV preparedness, high-risk diagnosis review and validation, audit support, and identification and escalation of potential coding or documentation compliance concerns.
 
5. Assists with extraction of charts via remote Electronic Medical Record (EMR) access or faxed medical record request for risk adjustment initiatives.
 
6. Performs comprehensive medical record review, verifying and ensuring accuracy, completeness, specificity, and appropriateness of diagnoses codes in accordance with ICD-10 guidelines based on medical record documentation. Documents trends, observations, and potential coding or documentation improvement opportunities identified during the review process.
 
7. Maintains a comprehensive tracking and management tool to track all coding activities; generates and maintains accurate weekly, monthly, and quarterly reports of activities.
 
8. Assists with chart review encounter data submissions to CMS based on chart review findings.
 
9. Provides support during the annual retrospective chart review performed by an external party.
 
10. Identifies, develops, and delivers general and specific educational guidance to providers and clinic staff through webinars, newsletters, presentations, and other educational forums based on risk adjustment audit findings, CMS guidelines, regulatory requirements, and industry best practices.
 
11. Collaborates with internal departments, as appropriate, to carry out risk adjustment program activities to ensure integrity of diagnoses attributed to members submitted to the Michigan Department of Health and Human Services (MDHHS) and CMS by UPHP.
 
12. Collaborates with healthcare leaders, physicians, and provider office personnel to improve the accuracy and completeness of diagnosis code capture. Facilitates provider education, documentation clarification, and coding-related discussions in a professional, consultative manner to support risk adjustment and compliance objectives. 
 
13. Maintains confidentiality of client data.
 
14. Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS:Education:Minimum:
High School Diploma
 Preferred:
Associate degree in business, health information processing, or related field 
 Certification:Minimum:
Must possess and maintain an American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification—Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC), or Certified Risk Adjustment Coder (CRC)
 Preferred:
Certified Coding Specialist (CCS-P, CCS, CPC) and Certified Risk Adjustment Coder (CRC)
 
Experience:Minimum:
Two (2) years of experience in medical chart coding
 Preferred:
Five (5) years of experience in medical chart coding, including inpatient and outpatient settings; working knowledge of managed care and health plan standards on Risk Adjustment Coding
 
Other Qualifications:
Knowledge and understanding of medical terminology, disease process, and anatomy and physiology
Advanced knowledge and understanding of CPT coding across a wide variety of provider specialties
 Required Skills:
Excellent organizational abilities with attention to detail
Ability to effectively communicate with, and educate, clinic staff (provider, care managers, clinic quality leads, etc.)
Working knowledge of Microsoft Office (Word, Excel, Outlook)
Keyboarding proficiency
Research and analytical skills
 Preferred Skills:
Knowledge of MS PowerPoint
Oriented to managed care
 
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
 
Physical Requirements: 
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
 
Ability to enter and access information from a computer
Occasionally lifts supplies/equipment
Prolonged periods of sitting
Manual dexterity 
 
Working Conditions:
Position available onsite (in Marquette, Michigan), fully remote, or hybrid with a remote work option up to three (3) days per week 
Works in office conditions, but occasional travel is required
Exposure to situations requiring exceptional interpersonal skills or high productivity
Occasionally subjected to irregular hours
Subject to many interruptions
 Remote Work Requirements:
Remote candidates must reside in the state of Michigan
For fully remote team members, initial on-site/in-person onboarding and training for a minimum of ten (10) consecutive business days at UPHP’s headquarters in Marquette, Michigan (stipend provided) 
Periodic travel to UPHP’s headquarters for regular training including all staff meetings
Private home office required; computer and phone hardware provided
Personal vehicle required for periodic travel; mileage reimbursement provided at GSA rate
Employment Type: FULL_TIME

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