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Risk Adjustment Manager Jobs (NOW HIRING)

Viva Health

Risk Adjustment Specialist

Birmingham, AL · On-site

$92K/yr

This position will assist the Manager of Risk Adjustment with other projects as needed. Why VIVA HEALTH? VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is ...

CommunityCare, Inc.

The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation ... Bachelor's degree in Health Information Management or related field preferred. * Previous auditing ...

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Risk Adjustment Manager information

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$43.5K

$103.7K

$167.5K

How much do risk adjustment manager jobs pay per year?

As of Sep 13, 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 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.

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Risk Adjustment Manager jobs near you
Infographic showing various Risk Adjustment Manager job openings in the United States as of September 2026, with employment types broken down into 87% Full Time, 12% Part Time, and 1% Contract. Highlights an 79% Physical, 2% Hybrid, and 19% Remote job distribution, with an average salary of $103,704 per year, or $49.9 per hour.

Sr. Manager, Risk Adjustment Analytics

Denver, CO • On-site

Staffingine LLC
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Staffingine LLCexternal

Full-time

Re-posted 4 days ago

Job description

Job Title: Sr Manager, Risk Adjustment Analytics 
Job Location: Denver, CO 
Job Type: Full Time 

Job Description:  

  • Provide strategic leadership and management for the IKC Risk Adjustment Accuracy 

  • Create and maintain leadership reports on IKC revenue financials and estimating impact IKC initiatives had on Medical Loss Ratio (MLR) 

  • Write SQL queries against data warehouses containing clinical operations and medical claims data to support analytic requests and deliver insights to various stakeholders 

  • Monitor evolving regulations and policies to ensure all processes and reporting meet compliance requirements 

  • Partner with clinical, financial, operational, legal, compliance, and IT teams to improve risk adjustment accuracy 

  • Serve as a subject matter expert on CMS risk adjustment for the enterprise and stay current on the latest industry trends 

  • Other duties as assigned 

Required Experience: 

  • 3 or more years’ professional experience with healthcare data, specifically medical claims and/or encounter data using SQL 

  • 3 or more years’ experience in healthcare financial management, healthcare consulting, medical economics, population health, and/or similar experience  

  • At least a year’s experience in creation, implementation, and impact estimation of prospective and retrospective risk adjustment initiatives, including CMS RAPS/Encounter data submissions 

  • Experience developing and managing direct reports 

Skills and knowledge needed to succeed in this role: 

  • Expert level knowledge of CMS-HCC models V24 and V28, claims data lifecycle, submission systems, regulation, compliance, and audits related to risk adjustment 

  • Strong understanding of healthcare economics, population health, and value based care 

  • Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization 

  • Comfortable presenting complex analysis and insights to executive audience 

  • Intellectual curiosity, strategic thinking and strong project management skills 

  • Comfort with ambiguous, ever-changing situations 

  • Strong entrepreneurial mindset with the motivation to continuously improve the status quo and drive this independently 

Must-haves 

  • Experience developing and managing direct reports Expert level knowledge of CMS-HCC models V24 and V28, claims data lifecycle, submission systems, regulation, compliance, and audits related to risk adjustment Strong understanding of healthcare economics, population health, and value based care Ability to work collaboratively in a cross functional team environment and communicate effectively with teammates at all levels in an organization Comfortable presenting complex analysis and insights to executive audience Intellectual curiosity, strategic thinking and strong project management skills Comfort with ambiguous, ever-changing situations Strong entrepreneurial mindset with the motivation to continuously improve the status quo and drive this independently