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Risk Adjustment Manager Jobs (NOW HIRING)

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82K - $108K/yr

You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs. You will report into the Manager, Risk Adjustment. Work Location: This is a ...

Aquity Solutions

Director Risk Adjustment - Remote

$130K - $150K/yr

Director of Risk Adjustment About IKS Health For more information, visit: www.ikshealth.com IKS ... Strategic Client Management: Serve as the primary operational partner for multiple external clients ...

TEKsystems

Risk Adjustment Coding Auditor

Phoenix, AZ · Remote

$32 - $37/hr

Risk Adjustment Coding Auditor Overview We are seeking a detail-oriented Risk Adjustment Coding ... Ability to manage multiple priorities in a deadline-driven environment. * High school diploma or ...

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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 Aug 12, 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?

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:
What states have the most Risk Adjustment Manager jobs? States with the most job openings for Risk Adjustment Manager jobs include:
What job categories do people searching Risk Adjustment Manager jobs look for? The top searched job categories for Risk Adjustment Manager jobs are:
Risk Adjustment Manager jobs near you
Infographic showing various Risk Adjustment Manager job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 58% In-person, 10% Hybrid, and 32% Remote job distribution, with an average salary of $103,704 per year, or $49.9 per hour.

Auditor, Risk Adjustment

Oscar Health

Dallas, TX • Remote

$82K - $108K/yr

Full-time

Re-posted 14 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

252nd of 304 rated insurance

Job description

Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

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 identified clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

You will report into the Manager, Risk Adjustment.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

  • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
  • Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
  • Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
  • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
  • Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
  • Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
  • Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business.
  • Manage the implementation process improvements that will maximize risk adjustment factor increases.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Bachelor's degree in a relevant field of study or commensurate work experience.
  • Certified professional coder (CPC)
  • 3+ year(s) retrospective risk adjustment coding experience.
  • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Bonus points:

  • Certified Risk Adjustment Coder (CRC) or similar certification
  • Experience coding in a variety of different Electronic Medical Record (EMR) systems.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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