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Risk Adjustment Coding 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

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 ...

CareSource

Applied AI Scientist III

Dayton, OH · On-site +1

... expertise and code reviews. Essential Functions: * Evaluate emerging technology in LLMs, NLP ... Work closely with interdisciplinary teams across IT, risk adjustment, program integrity, HEDIS ...

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All JobsRisk Adjustment Coding JobsRisk Adjustment Coding Jobs in Ohio

Risk Adjustment Coding information

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$16

$27

$67

How much do risk adjustment coding jobs pay per hour?

As of Aug 2, 2026, the average hourly pay for risk adjustment coding in Ohio is $27.84, according to ZipRecruiter salary data. Most workers in this role earn between $20.82 and $27.64 per hour, depending on experience, location, and employer.

Is HCC coding a good career?

Risk adjustment coding, including HCC coding, is a growing field with strong job demand due to the increasing focus on value-based care and accurate risk assessment. It requires attention to detail, knowledge of medical terminology, and often certification, making it a stable career option for those interested in healthcare and coding. Opportunities exist in healthcare organizations, insurance companies, and consulting firms.

What is a risk adjustment coder?

A risk adjustment coder is a healthcare professional responsible for reviewing medical records and assigning accurate diagnosis codes to reflect patient health status. Their work supports insurance reimbursement and quality measurement by ensuring proper risk adjustment, often requiring knowledge of coding systems like ICD-10 and certification such as CPC.

What is risk adjustment coding?

Risk adjustment coding is the process of assigning standardized diagnosis codes to patient records to accurately reflect their health status and predict future healthcare costs. These codes are used by health plans and government programs to adjust payments based on the complexity and severity of patient conditions. Proper risk adjustment coding ensures fair reimbursement and supports quality care management by identifying high-risk patients who may require additional resources.

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

AspectRisk Adjustment CodingMedical Coding
CredentialsCPR, CPC, or CCS certifications often preferredCPR, CPC, or CCS certifications
Work EnvironmentHealthcare facilities, insurance companies, remoteHospitals, clinics, physician offices
Industry UsageHealth plans, risk adjustment programsGeneral healthcare billing and documentation

Risk Adjustment Coding focuses on assigning codes that predict healthcare costs and risk for insurance purposes, often requiring understanding of patient risk factors. Medical Coding covers a broader range of diagnoses and procedures for billing and documentation. While both roles require similar certifications, their work environments and industry applications differ significantly.

How much does a CRC coder make?

A Certified Risk Adjustment Coder (CRC) typically earns between $50,000 and $70,000 annually, depending on experience, location, and employer. Certification and proficiency with coding tools like ICD-10 are important factors that can influence salary levels.

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, healthcare regulations, and anatomy, typically supported by certification such as CPC or CRC. Familiarity with coding software, EHR systems, and risk adjustment models like HCC or CMS-HCC is crucial. Attention to detail, analytical thinking, and effective communication are standout soft skills for this role. These skills ensure accurate coding, compliance, and optimized reimbursement, which are vital for healthcare organizations' financial and regulatory success.

What are some common challenges faced by professionals in risk adjustment coding, and how can they be managed?

Risk adjustment coders often encounter challenges such as keeping up with frequent updates to coding guidelines, ensuring complete and accurate documentation, and managing high volumes of medical records. To address these challenges, effective time management, continuous education on coding standards (like ICD-10-CM), and regular communication with healthcare providers are essential. Many coders also rely on auditing tools and ongoing feedback from team leads to improve accuracy and compliance, fostering a collaborative and supportive work environment.

How to get into risk adjustment coding?

To enter risk adjustment coding, individuals typically need a background in medical coding, health information management, or related healthcare fields, along with certification such as the Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Gaining experience with medical records, coding software, and understanding diagnosis and procedure coding guidelines is essential. Many employers also value familiarity with risk adjustment models and coding for chronic conditions.
What are the most commonly searched types of Risk Adjustment Coding jobs in Ohio? The most popular types of Risk Adjustment Coding jobs in Ohio are:
What are popular job titles related to Risk Adjustment Coding jobs in Ohio? For Risk Adjustment Coding jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Risk Adjustment Coding jobs in Ohio look for? The top searched job categories for Risk Adjustment Coding jobs in Ohio are:
What cities in Ohio are hiring for Risk Adjustment Coding jobs? Cities in Ohio with the most Risk Adjustment Coding job openings:
Risk Adjustment Coding jobs near you
Infographic showing various Risk Adjustment Coding 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 $57,916 per year, or $27.8 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 26 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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