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

Veradigm

Expert Client Success Manager

Raleigh, NC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Expert Client Success Manager Job Summary The Expert Client Success Manager (CSM) serves as the ... risk adjustment, CMS, and healthcare industry processes Compensation for this job is subject to ...

Veradigm

Expert Client Success Manager

Raleigh, NC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Expert Client Success Manager Job Summary The Expert Client Success Manager (CSM) serves as the ... risk adjustment, CMS, and healthcare industry processes Compensation for this job is subject to ...

Varsity Tutors

Finance Tutor

Chapel Hill, NC · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... management courses. * Effective Teaching Methods: Ability to identify concepts students commonly ...

Varsity Tutors

Finance Tutor

Durham, NC · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... management courses. * Effective Teaching Methods: Ability to identify concepts students commonly ...

Deloitte

Health Actuary Consulting Manager

Raleigh, NC · On-site

... risk adjustment mechanisms, group insurance products, mergers and acquisitions, or health care ... As an Actuarial Manager, you will apply actuarial, strategic, and analytical experience to help ...

Varsity Tutors

Finance Tutor

Raleigh, NC · Remote

$18 - $40/hr

... risk adjustment in valuation, and interpreting financial ratios. Adapts instruction using financial ... management courses. * Effective Teaching Methods: Ability to identify concepts students commonly ...

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

Risk Adjustment Manager information

See Raleigh, NC salary details

$42.3K

$100.8K

$162.8K

How much do risk adjustment manager jobs pay per year?

As of Aug 18, 2026, the average yearly pay for risk adjustment manager in Raleigh, NC is $100,809.00, according to ZipRecruiter salary data. Most workers in this role earn between $70,500.00 and $128,300.00 per year, depending on experience, location, and employer.

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?

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 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 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.

What are popular job titles related to Risk Adjustment Manager jobs in Raleigh, NC?

For Risk Adjustment Manager jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Risk Adjustment Manager jobs in Raleigh, NC look for?

The top searched job categories for Risk Adjustment Manager jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Risk Adjustment Manager jobs?

Cities near Raleigh, NC with the most Risk Adjustment Manager job openings:

Risk Adjustment Manager jobs near you
Infographic showing various Risk Adjustment Manager job openings in Raleigh, NC as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $89,061 per year, or $42.8 per hour.

Lead Actuarial Analyst, MA Risk Adjustment

Strive Health

Raleigh, NC

$99K - $124K/yr

Full-time

Medical

Re-posted 20 days ago

Job description

What You'll Do

We are seeking a Lead Actuarial Analyst, MA Risk Adjustment to join our high-performing, insights-driven team. You will play a critical role in evaluating financial performance, uncovering areas of opportunity, and use your 3+ actuarial exam progress to help translate complex data into actionable strategies. Your work will directly influence how Strive supports patients, clinicians, and markets in achieving both clinical and financial success. (This position is internally titled Lead Analyst, Risk Adjustment Analytics). We offer a competitive Actuarial Study Program designed to help you succeed, including exam fee support, study resources, and rewards for passing exams and achieving actuarial credentials.

Essential Functions 

  • Translate RA performance data into clear financial insights (i.e. revenue impact, payment accuracy, ROI, forecasting). 
  • Analyze CMS data to identify areas of opportunity to increase operational efficiency. 
  • Interpret trends, model scenarios, and assess program and policy impacts. 
  • Enable data-driven decisions by linking operational performance to enterprise financial outcomes. 
  • Perform end-to-end reconciliation from submissions to CMS acceptance, RAF leakage, and implement controls. 
  • Develop business cases to assess opportunity, determine target metrics, and provide data driven insights to support investment decisions (i.e. staffing, tech, etc.). 
  • Prepare and deliver clear and concise reports, presentations, and recommendations to senior leadership, illustrating the findings and implications of analyses conducted. 

Who You Are 

  • A highly analytical problem-solver with a strong sense of ownership and intellectual curiosity. 
  • Able to manage a high volume of recurring and ad hoc deliverables without compromising quality. 
  • Comfortable navigating ambiguity and bringing structure to complex problems. 
  • An exceptional communicator who can translate technical findings into actionable business recommendations. 

Qualifications 

  • 4+ years of experience in risk adjustment analytics. 
  • 4+ years of experience analyzing MMR, MOR, MAO-004 and medical claims data. 
  • 3+ actuarial exams passed. 
  • High degree of proficiency in Microsoft Excel and SQL.  
  • Experience with PBI, Redshift, dbt docs is a plus. 
  • Bachelor's degree in a quantitative or health-related field (e.g., Economics, Public Health, Statistics, Health Services Research, Math, Finance). 

Annual Salary Range: $99,000 - $124,000. This position is also eligible for a target annual bonus of 10%

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