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How much do risk adjustment coding specialist jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for risk adjustment coding specialist in the United States is $27.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.12 and $32.69 per hour, depending on experience, location, and employer.

What is a risk adjustment coding specialist?

Risk Adjustment Coding Specialists are healthcare professionals who review medical records and assign appropriate diagnosis codes to ensure accurate risk adjustment for health plans. Their work helps healthcare organizations receive proper reimbursement by capturing the complexity of patient conditions. They must be familiar with ICD-10-CM coding guidelines and often work with Medicare Advantage or other risk-adjusted programs. Attention to detail and knowledge of compliance regulations are essential in this role.

What are the key skills and qualifications needed to thrive as a risk adjustment coding specialist?

To thrive as a Risk Adjustment Coding Specialist, you need a thorough understanding of medical coding (ICD-10-CM), healthcare documentation, and risk adjustment models, often supported by a coding certification such as CPC, CRC, or CCS. Proficiency with electronic health records (EHR) systems, coding software, and data analytics tools is typically required. Exceptional attention to detail, analytical thinking, and clear communication are vital soft skills for accurately interpreting clinical notes and collaborating with healthcare providers. These skills ensure accurate risk adjustment coding, compliance with regulations, and optimal reimbursement for healthcare organizations.

What are some common challenges faced by risk adjustment coding specialists in ensuring accurate coding for risk adjustment models?

Risk Adjustment Coding Specialists often encounter challenges such as interpreting complex medical documentation, staying updated with frequent changes in coding guidelines (like ICD-10-CM), and ensuring complete capture of all relevant diagnoses for accurate risk scoring. They must work closely with providers to clarify ambiguous documentation and ensure compliance with regulatory requirements. Attention to detail and ongoing education are crucial in this role to maintain coding accuracy and support optimal reimbursement for healthcare organizations.

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

AspectRisk Adjustment Coding SpecialistMedical Coder
CertificationsAHIMA or AAPC certifications, risk adjustment trainingAHIMA or AAPC certifications, general coding credentials
Work EnvironmentHealthcare organizations, insurance companies, risk adjustment teamsHospitals, clinics, physician offices
Industry UsagePrimarily in health plans and risk adjustment programsBroadly in healthcare for billing and documentation

The Risk Adjustment Coding Specialist focuses on coding for risk adjustment purposes within health plans, requiring specialized knowledge of risk models. Medical Coders have a broader role in medical billing and coding across various healthcare settings. While both roles require coding certifications, the Risk Adjustment Coding Specialist emphasizes risk models and payer requirements, making it more specialized for health plan accuracy and compliance.

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Risk Adjustment Coding Specialist jobs near you
Infographic showing various Risk Adjustment Coding Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 8% Part Time, and 3% Contract. Highlights an 87% Physical, 5% Hybrid, and 8% Remote job distribution, with an average salary of $57,000 per year, or $27.4 per hour.

Risk Adjustment Coding Specialist II

KZX - Astrana Health Management, Inc.

Orange, CA • On-site

Other

Posted 6 days ago

Job description

Risk Adjustment Coding Specialist

We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects.

Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

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