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Risk Adjustment Coding Jobs (NOW HIRING)

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82.72K - $108.57K/yr

The Associate, Risk Adjustment Auditor conducts internal and external quality audits ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

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Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82.72K - $108.57K/yr

The Associate, Risk Adjustment Auditor conducts internal and external quality audits ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

New

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82.72K - $108.57K/yr

The Associate, Risk Adjustment Auditor conducts internal and external quality audits ... Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and ...

New

Suvida

Provider Coding Educator

Houston, TX · On-site

$26 - $29.50/hr

This role ensures that providers understand and comply with risk adjustment guidelines to optimize accurate documentation and coding, which in turn supports quality care to patients. Responsibilities

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How much do risk adjustment coding jobs pay per hour?

As of May 31, 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 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.

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.

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Risk Adjustment Coding jobs near you
Infographic showing various Risk Adjustment Coding job openings in the United States as of May 2026, with employment types broken down into 96% Full Time, 1% Part Time, and 3% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $60,920 per year, or $29.3 per hour.
Risk Adjustment Coder - Risk Management

Risk Adjustment Coder - Risk Management

Kettering Health

Kettering, OH

Full-time

Posted 5 days ago

Kettering Health rating

7.3

Company rating: 7.3 out of 10

Based on 181 frontline employees who took The Breakroom Quiz

289th of 864 rated healthcare providers

Job description

Job Details

Physician Office | Kettering | Full-Time | First Shift

Responsibilities & Requirements

Responsibilities & Requirements

This position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation. 

KPN Pro Fee Coding Specialist

Serves as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines.

  • Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits
  • Reviewing the ambulatory records for the appropriate risk adjustment components
  • Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes
  • Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10
  • Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy]
  • Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits
  • Corresponds with providers on pending claims to facilitate resolution
  • Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies
  • Communicate appropriately with providers, leaders, and staff
  • Researches and resolves concerns timely

The Risk Adjustment Coder is responsible for coding and abstracting all outpatient patient records using ICD-10-CM and CPT/HCPCS coding rules, federal guideline and KMCN guidelines. Additionally, the Risk Adjustment Coder supports hospital's accounts receivable goals through timely processing of records and physician record completion activities. Impacts delivery of quality patient care and enhanced clinical decision-making process. Supports clinical outcomes measurement and assessment process for service lines. Completes assigned duties and other related tasks. The list is not inclusive, Performs other duties as assigned.

 The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records.  The Risk Adjustment Coder will contribute to overarching educational efforts of the MSO regarding Risk Adjustment.  The Risk Adjustment Coder will offer summarized content, feedback from providers, key barriers or success efforts to executive leaders to assist in the overall risk adjustment of the population. 

The Risk Adjustment Coder will spend some in-person time with providers to foster a relationship and encourage dialogue with risk adjustment to improve overall outcomes. The Risk Adjustment Coder will develop a collegial relationship with the Clinical Documentation Specialist RN (CDS) to partner on the overarching risk adjustment of the population.

Educational Requirements:

High School Diploma or equivalent

RHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certification

Prior experience in professional fee coding/billing

CRC required within 1 year of hire

Overview

Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God's love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.

Employment Type: FULL_TIME

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