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Risk Adjustment Coding Jobs in Raleigh, NC (NOW HIRING)

The Preiss Company

Property Manager

Knightdale, NC

Oversee the accounts payable process, and monitor the timely receipt, reconciliation, and coding of ... Risk Management * Identify and address any safety and security risks. Communicate incidents and ...

New

Preiss

Property Manager

Knightdale, NC · On-site

Oversee the accounts payable process, and monitor the timely receipt, reconciliation, and coding of ... Risk Management * Identify and address any safety and security risks. Communicate incidents and ...

New

PIVOT Workforce

Project Manager

Raleigh, NC · On-site

Apply in-depth knowledge of HVAC systems, codes, and standards to ensure compliance and optimize ... Risk Management: Identify potential risks and develop mitigation strategies to keep projects on ...

UNC Health

CT Technologist II - Rex CT Scan

Raleigh, NC

$35.87 - $51.57/hr

... and adjustment of scan parameters limiting radiation dosage. 3) Evaluates any contra-indications ... Demonstrates ability to train CT Tech I team members on these and other high-risk exams/procedures ...

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All JobsRisk Adjustment Coding JobsRisk Adjustment Coding Jobs in Raleigh, NC

Risk Adjustment Coding information

See Raleigh, NC salary details

$16

$28

$68

How much do risk adjustment coding jobs pay per hour?

As of Jul 29, 2026, the average hourly pay for risk adjustment coding in Raleigh, NC is $28.47, according to ZipRecruiter salary data. Most workers in this role earn between $21.25 and $28.27 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 Raleigh, NC? The most popular types of Risk Adjustment Coding jobs in Raleigh, NC are:
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What job categories do people searching Risk Adjustment Coding jobs in Raleigh, NC look for? The top searched job categories for Risk Adjustment Coding jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Risk Adjustment Coding jobs? Cities near Raleigh, NC with the most Risk Adjustment Coding job openings:
Risk Adjustment Coding jobs near you
Infographic showing various Risk Adjustment Coding job openings in Raleigh, NC as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $59,215 per year, or $28.5 per hour.

Systems Analyst - Payer Encounter Management Platform

Veradigm

Raleigh, NC • On-site

$69K - $97K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 3 days ago

Job description

Veradigm is a healthcare analytics and technology company that helps health plans and at-risk providers improve Risk Adjustment and Quality outcomes across HIX, Medicare Advantage, and Medicaid. With advanced analytics and real-time intelligence, we give clients clear visibility into member and provider activity so they can close documentation, coding, and quality gaps more efficiently.
The Veradigm Encounter Management Platform is a centralized solution that processes, validates, and submits encounter and supplemental data for Medicare, Medicaid, ACA, and other government programs. It streamlines ingestion, edit resolution, submission readiness, and CMS response handling, giving health plans and BPO partners a reliable, compliant way to manage large-scale encounter operations.
Job Summary
The Systems Analyst works primarily with enterprise customers of Veradigm's Encounter Management Platform, proactively assisting them with post- sales installation, configuration, upgrade, troubleshooting and day to day operational management. Responsibilities include taking a proactive leadership role working with the Engineering team and Customers to triage and resolve highly complex, technical, and application-related issues which impact product performance in customer-specific environments, or issues that directly hamper a broader customer adoption of Veradigm's Encounter Management Platform. In addition to working with customers, the Systems Analyst will routinely partner with our Development, Sustaining Engineering and Sales Engineering organizations to resolve support issues, document bugs, provide UAT on product builds, and ensure that new and newly upgraded server installations are successful.
What you will contribute:
  • Support encounter data reporting processes for EDPS, RAPS and the EDGE server, including tracking, reporting, and resolving rejections
  • Conduct gap analysis and data validation, identifying possible issues in data submission and determining financial impact.
  • Analyze and reconcile claims and encounter data which will include 837 EDI encounter files for EDPS, RAPS and Edge Server submission files
  • Perform research in the encounter management system and liaison with the CSSC Helpdesk for exception resolution
  • Be comfortable with raw data files in their native format and accessing these through various servers
  • Partner with Product Support Engineers and development teams as necessary
  • Assist development team with performance analysis and testing during release cycles for service packs, hot fixes etc
  • Answer email and phone requests for help from customers
  • Collaborate in virtual teamwork with other Product Support staff
  • Host online troubleshooting and investigation sessions on customer's production environments
  • Deliver a consistent, responsive and satisfying customer experience with each contact
  • Collect all necessary problem details from customers to be able to effectively see the problem to resolution
  • Successfully reproduce customer issues in a controlled test environment
  • Follow standard operational procedures for case management
  • Continuously improve troubleshooting skills, product expertise, and knowledge on related technical topics
  • Perform ACA and MA Submissions for Clients
  • Understand RAPS and EDPS filtering logic which CMS uses for Risk Adjustment and/or Risk Score calculations
  • Monitor CMS data submission deadlines for both MA and ACA lines of business

The ideal candidate will have:
Academic and Professional Qualifications:
• Bachelor's Degree in Health IT/Informatics/Management Information Systems or related field required
Experience:
  • 2+ years of professional experience in Risk Adjustment data management
  • Understanding of claims data, encounter response files, 837 EDI encounter files, EDGE/MA billing & business rules as well as MA filtering logic for EDPS
  • Experience with CMS Submissions Process and EDI transactions
  • Excellent time management and organizational skills necessary
  • Prior experience troubleshooting performance problems that may have many underlying causes such as Disk, Database, Network, Messaging and other platform / 3rd party solutions
  • Experience with managing product back end and webservices
  • Ability to guide customers remotely through complex, multi-server deployments and upgrades for enterprise products
  • Familiarity with EDI Standards such as X12, EDIFACT, HL7, NCPDP and knowledge of HIPAA transactions
  • Prior knowledge of 837's along with various loops and segments and an understanding of the requirements set forth by CMS for EDPS submission files
  • Working knowledge in SQL scripts is a plus
  • Good written and verbal skills.
  • Knowledge in CMS model changes is a plus
  • Knowledge in CMS Risk Score and Risk Adjustment methodologies is a plus
  • Knowledge in Medicaid is a plus

Travel Requirements:
Less than 5%
Compensation Range:
$69,852-$97,094
Compensation for this job is subject to market conditions, geographic considerations, the candidate's unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates' unique contributions and support their professional growth.
Enhancing Lives and Building Careers
Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?
Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.
We strongly advocate that our associates receive all CDC recommended vaccinations in prevention of COVID-19.
Visa Sponsorship is not offered for this position.
At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.
Veradigm's policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.
From a "VEVRAA Federal Contractor" We request Priority Referral of Protected Veterans
This is an official Veradigm Job posting. To avoid identity theft, please only consider applying to jobs posted on our official corporate site.
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