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Risk Adjustment Coder Jobs in Virginia (NOW HIRING)

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 ...

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Risk Adjustment Coder information

See Virginia salary details

$15

$27

$43

How much do risk adjustment coder jobs pay per hour?

As of Aug 2, 2026, the average hourly pay for risk adjustment coder in Virginia is $27.26, according to ZipRecruiter salary data. Most workers in this role earn between $18.85 and $34.33 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.
What are the most commonly searched types of Risk Adjustment Coder jobs in Virginia? The most popular types of Risk Adjustment Coder jobs in Virginia are:
What are popular job titles related to Risk Adjustment Coder jobs in Virginia? For Risk Adjustment Coder jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Risk Adjustment Coder jobs in Virginia look for? The top searched job categories for Risk Adjustment Coder jobs in Virginia are:
What cities in Virginia are hiring for Risk Adjustment Coder jobs? Cities in Virginia with the most Risk Adjustment Coder job openings:
Risk Adjustment Coder jobs near you
Infographic showing various Risk Adjustment Coder job openings in Virginia as of July 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $56,691 per year, or $27.3 per hour.

Consulting Actuary - ACA Risk Adjustment

Blue Cross and Blue Shield of North Carolina

Virginia Beach, VA • 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

187th 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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