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Risk Adjustment Coder Jobs in Ohio (NOW HIRING)

Premier Health

PHYSICIAN ADVISOR

Dayton, OH · On-site

This role focuses on optimizing case mix index (CMI), risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding, and Quality teams. The Physician Advisor ...

Premier Health

PHYSICIAN ADVISOR

Dayton, OH · On-site

This role focuses on optimizing case mix index (CMI), risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding, and Quality teams. The Physician Advisor ...

Premier Health

PHYSICIAN ADVISOR

Dayton, OH · On-site

This role focuses on optimizing case mix index (CMI), risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding, and Quality teams. The Physician Advisor ...

Premier Health

PHYSICIAN ADVISOR

Dayton, OH

This role focuses on optimizing case mix index (CMI), risk adjustment, and clinical documentation excellence through collaboration with the CDI, Coding, and Quality teams. The Physician Advisor ...

Wooster Community Hospital

Coder

Wooster, OH · On-site

The Coder is responsible to review, abstract, assign appropriate ICD10-CM, CPT and DRG codes as needed to all patient charts/accounts. Assists the revenue cycle team by performing audits to detect ...

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All JobsRisk Adjustment Coder JobsRisk Adjustment Coder Jobs in Ohio

Risk Adjustment Coder information

See Ohio salary details

$15

$26

$41

How much do risk adjustment coder jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for risk adjustment coder in Ohio is $26.14, according to ZipRecruiter salary data. Most workers in this role earn between $18.08 and $32.88 per hour, depending on experience, location, and employer.

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.

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.
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What job categories do people searching Risk Adjustment Coder jobs in Ohio look for? The top searched job categories for Risk Adjustment Coder jobs in Ohio are:
What cities in Ohio are hiring for Risk Adjustment Coder jobs? Cities in Ohio with the most Risk Adjustment Coder job openings:
Risk Adjustment Coder jobs near you
Infographic showing various Risk Adjustment Coder job openings in Ohio 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 $54,363 per year, or $26.1 per hour.

Consulting Actuary - ACA Risk Adjustment

Blue Cross and Blue Shield of North Carolina

Columbus, OH • On-site

$143K - $229K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 28 days ago

Blue Cross and Blue Shield of North Carolina rating

7.8

Company rating: 7.8 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

188th of 301 rated insurance

Job description

Job Description

As a Consulting Actuary -ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating advanced care management models, conducting competitive benchmarking analyses, and designing and pricing sophisticated insurance products. You will support company objectives by providing reliable, actionable actuarial insights and recommendations, proactively identifying and addressing complex risks and opportunities. This position requires adaptability to the evolving landscape of the industry, ensuring our actuarial practices remain at the forefront of innovation and excellence.

What You'll Do

  • Accountable for completion of complex actuarial or analytical projects, ensuring timeliness, compliance, and quality of work

  • Provide proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for Blue Cross NC customers

  • Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company

  • Communicate effectively with all levels and divisions within the organization, including Divisional Leadership

  • Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates

  • Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor

  • Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials

What You Bring

  • Bachelor's degree or advanced degree (where required)

  • Member of the American Academy of Actuaries

  • Fellow of the Society of Actuaries

  • 7 years of relevant actuarial experience, related experience may be considered.

  • In lieu of an FSA, will consider candidates who are an Associate of the Society of Actuaries (ASA) and have at least 9 years of relevant actuarial experience.

Bonus Points

  • Deep experience with ACA Risk Adjustment, including HHS-HCC model methodology, risk score forecasting, and financial impact analysis - Highly Preferred

  • Proven expertise in ACA Risk Adjustment transfer forecasting and explanation of results to senior leadership - Highly Preferred

  • Strong understanding of diagnosis coding (ICD-10-CM), provider documentation practices, and their impact on risk adjustment outcomes.

  • Advanced analytical skills to identify risk adjustment leakage, emerging risks, and optimization opportunities across ACA populations

What You'll Get

  • The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.

  • Work-life balance, flexibility, and the autonomy to do great work.

  • Medical, dental, and vision coverage along with numerous health and wellness programs.

  • Parental leave and support plus adoption and surrogacy assistance.

  • Career development programs and tuition reimbursement for continued education.

  • 401k match including an annual company contribution

  • Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$143,616.00 - $229,786.00

Skills

Actuarial Analysis, Actuarial Management, Actuarial Science, Actuarial Services, Affordable Care Act (ACA), Complex Care Management, Financial Reporting and Analysis, Hiring Management, Insurance Industry, Organizational Leadership, Regulatory Compliance

_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

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