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How much do risk adjustment coding jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for risk adjustment coding in the United States is $29.29, according to ZipRecruiter salary data. Most workers in this role earn between $21.88 and $29.09 per hour, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive as a risk adjustment coder?

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.

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 do risk adjustment coders make in the US?

Risk adjustment coders in the US typically earn between $50,000 and $75,000 annually, depending on experience, certifications, and location. Entry-level positions may start around $45,000, while experienced coders with certifications like CPC or CCS can earn over $80,000. The role often requires knowledge of medical coding systems and familiarity with healthcare data analysis.

How to get into risk adjustment coding?

To enter risk adjustment coding, individuals typically need a medical coding certification such as CPC or CCS, along with knowledge of medical records and coding guidelines. Experience in healthcare or medical billing can be beneficial, and familiarity with electronic health records (EHR) systems is often required. Ongoing education and staying current with coding updates are important for success in this field.

What do risk adjustment coders do?

Risk adjustment coders review and assign medical codes to patient records to accurately reflect diagnoses and health conditions, which are used to calculate risk scores for insurance reimbursement and quality measurement. They ensure coding accuracy and compliance with industry standards, often using coding tools and guidelines such as ICD-10 and CPT. Attention to detail and knowledge of medical documentation are essential for this role.
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Risk Adjustment Coding jobs near you
Infographic showing various Risk Adjustment Coding 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 $60,920 per year, or $29.3 per hour.

Risk Adjustment Coding Specialist II

Astrana Health, Inc.

Orange, CA • On-site, Remote

$70K - $85K/yr

Full-time

Posted 16 days ago

Job description

Description
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

What You'll Do
  • Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company 
  • Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC) 
  • Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines 
  • Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation 
  • Meets or exceeds productivity targets as established by management. Regularly meets due dates assigned 
  • Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing 
  • Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements. 
  • Keeps management apprised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success. 
  • Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives. 
  • Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. 
  • Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager. 
  • May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I 

Qualifications
  • Required Certification/Licensure: Must possess and maintain AAPC or AHIMA certification – Certified Coding Specialist (CCS) and/or Certified Professional Coder (CPC). Certified Risk Adjustment Coder (CRC) is a plus but not required
  • 3+ years experience in risk adjustment coding and/or billing experience required 
  • Reliable transportation/Valid Driver’s License/Must be able to travel at least 75% of work time 
  • PC skills and experience using Microsoft applications such as Word, Excel, and PowerPoint
  • Excellent presentation, verbal and written communication skills, and ability to collaborate
  • Must possess the ability to educate and train provider office staff members 
  • Proficiency with healthcare coding software and Electronic Health Records (EHR) systems. 
You’re great for the role if: 
  • Have knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) for Medicare Advantage 
  • Ability to work independently and collaborate in a team setting 
  • Strong organizational and time-management skills 
  • Ability to work in a home office for continuous periods of time for business continuity 
  • Ability to travel across the Provider Clinic service region for meetings and/or training as needed 
  • Able to work independently and within time constraints
  • Able to efficiently prioritize multiple high-priority tasks

Environmental Job Requirements and Working Conditions
  • This position blends on-site fieldwork (approximately 75% travel) with remote support to help practices. The Company reserves the right to modify the work arrangement, including transitioning to a hybrid or onsite model, based on business needs. Disclaimer: This job description is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all responsibilities, duties, or qualifications required. Responsibilities may change based on business needs and organizational priorities.
  • The national target pay range for this role is $70,000 - $85,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. 
 
Additional Information: 
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.