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$43.5K

$103.7K

$167.5K

How much do risk adjustment manager jobs pay per year?

As of Jun 11, 2026, the average yearly pay for risk adjustment manager in the United States is $103,704.00, according to ZipRecruiter salary data. Most workers in this role earn between $72,500.00 and $132,000.00 per year, depending on experience, location, and employer.

What are the common challenges faced by a Risk Adjustment Manager in ensuring accurate coding and documentation?

Risk Adjustment Managers often encounter challenges in maintaining consistent and accurate documentation and coding across multiple providers and departments. Ensuring compliance with regulatory guidelines, keeping up with frequent changes in risk adjustment models, and training staff on proper coding practices are ongoing responsibilities. Additionally, they must regularly audit clinical records, collaborate with medical practitioners, and address discrepancies or gaps in coding to optimize reimbursement and minimize compliance risks. Effective communication and strong analytical skills are essential to overcome these challenges and drive continuous improvement.

What is a Risk Adjustment Manager?

A Risk Adjustment Manager is a professional who oversees the processes that ensure healthcare organizations accurately report patient diagnoses and health conditions for risk adjustment purposes. They manage teams and systems responsible for collecting, analyzing, and submitting data to regulatory agencies and insurers. Their work helps healthcare organizations receive appropriate reimbursement by aligning payments with the predicted cost of patient care based on risk factors. Risk Adjustment Managers also ensure compliance with government regulations and help implement best practices in data accuracy and quality. This role often involves collaboration with coding, clinical, and IT teams.

What are the key skills and qualifications needed to thrive as a Risk Adjustment Manager, and why are they important?

To thrive as a Risk Adjustment Manager, you need expertise in healthcare data analytics, knowledge of risk adjustment methodologies (such as HCC), and experience with regulatory compliance, typically supported by a degree in healthcare administration, business, or a related field. Familiarity with risk adjustment software, healthcare coding systems (like ICD-10 and CPT), and data management tools is crucial. Strong leadership, problem-solving, and communication skills are essential for managing teams and collaborating across departments. These skills ensure accurate risk scoring, optimize reimbursement, and maintain regulatory compliance within healthcare organizations.

What is the difference between Risk Adjustment Manager vs Coding Specialist?

AspectRisk Adjustment ManagerCoding Specialist
CredentialsTypically requires CPC, CCS, or RHIT certificationsUsually requires CPC or CCS certifications
Work EnvironmentOversees risk adjustment processes, collaborates with clinical and coding teamsFocuses on medical coding and documentation accuracy
Employer & Industry UsageHealth plans, insurance companies, healthcare providersHospitals, clinics, billing companies

The Risk Adjustment Manager and Coding Specialist roles share common certifications and work within healthcare settings, but the manager oversees risk strategies and team coordination, while the coding specialist concentrates on accurate medical coding. Both roles are essential for compliance and reimbursement, but differ in scope and responsibilities.

More about Risk Adjustment Manager jobs
What cities are hiring for Risk Adjustment Manager jobs? Cities with the most Risk Adjustment Manager job openings:
What are the most commonly searched types of Risk Adjustment jobs? The most popular types of Risk Adjustment jobs are:
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Risk Adjustment Manager jobs near you
Infographic showing various Risk Adjustment Manager job openings in the United States as of June 2026, with employment types broken down into 83% Full Time, and 17% Contract. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $103,704 per year, or $49.9 per hour.
Risk Adjustment Data Analyst

Risk Adjustment Data Analyst

The Health Plan of West Virginia Inc

Wheeling, WV • On-site

Full-time

Posted 3 days ago

Job description

Position Summary:

The Risk Adjustment Data Analyst will support The Health Plan’s risk adjustment management program with regard to risk adjustment models and guidance. This position will be involved in gathering, analyzing and reporting on data from multiple sources (e.g. member data, provider data, claims/enrollment processing, risk adjustment operations, analytical software and other resources) to extract trends and business insights to improve efficiencies and effectiveness of the risk adjustment management program.

Qualifications Required:

  1. College degree or a combination of education/experience in the health care industry.
  2. Computer experience with Microsoft Word, Excel, Power Point and Outlook
  3. Strong organizational, verbal and written communication skills balancing an independent and team working environment.
  4. Experience in data collection, analysis and visualization methods
  5. Previous work in a medical, managed care, or data driven organization(s).
  6. Ability to prioritize tasks in an environment with multiple (sometimes competing) priorities
  7. Experience with Microsoft SQL Server, MySQL and Power BI

Qualifications Desired:

  1. Proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems
  2. Experience in a federally regulated environment
  3. Medical terminology
  4. Knowledge of ICD and CPT coding (prefer certification)
  5. Familiar with medical and hospital claims
  6. Possess a working knowledge of quality improvement principles, theory, study design and statistical modeling, forecasting and benchmarking.

Essential Functions and Responsibilities:

  1. Develop and analyze reporting to support risk adjustment management programs/operations.
  2. Supports reporting requirements as needed for governmental and accreditation processes.
  3. Assist with submission, monitoring, and error management of encounter data to the CMS, BMS, and the EDGE server in accordance with models and guidelines.
  4. Supports reporting to identify inefficiencies to develop modifications in processes currently being used within the risk adjustment management program.
  5. Interfaces with staff and providers to support overall risk adjustment management programs with reporting.
  6. Interfacing with, gathering information from and preparing data for presentations to various levels of management, committees, internal and external partners.
  7. Utilizes databases, analytical software programs, and reporting tools to extract data, generate reports, perform moderate to complex data analysis to identify trends within a population and potential for system/process improvement.
  8. Attend continuing education classes/seminars to maintain professional and technical knowledge of State/Federal requirements.

Non-Essential Functions

1. Perform other related duties as assigned.



8:00am - 5:00pm
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