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Risk Adjustment Jobs in Rochester, NY (NOW HIRING)

Varsity Tutors

Finance Tutor

Rochester, NY · Remote

$18 - $40/hr

Familiar with undergraduate finance curricula and common challenges such as mastering time value of money calculations, understanding risk adjustment in valuation, and interpreting financial ratios.

OX Group

Demand Planner

West Henrietta, NY

Monitor stock levels and recommend adjustments to avoid overstock or stockouts. Sales & Operations ... Risk Management: * Identify potential risk to demand plans and develop mitigation strategies.

OX Tools

Demand Planner

West Henrietta, NY · On-site

Monitor stock levels and recommend adjustments to avoid overstock or stockouts. Sales & Operations ... Risk Management : * Identify potential risk to demand plans and develop mitigation strategies.

OX Tools

Demand Planner

West Henrietta, NY · On-site

$65 - $105/hr

Monitor stock levels and recommend adjustments to avoid overstock or stockouts. Sales & Operations ... Risk Management: * Identify potential risk to demand plans and develop mitigation strategies.

OX Group

Demand Planner

West Henrietta, NY · On-site

$60K - $80K/yr

Monitor stock levels and recommend adjustments to avoid overstock or stockouts. Sales & Operations ... Risk Management: * Identify potential risk to demand plans and develop mitigation strategies.

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All JobsRisk Adjustment JobsRisk Adjustment Jobs in Rochester, NY

Risk Adjustment information

See Rochester, NY salary details

$14

$29

$73

How much do risk adjustment jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for risk adjustment in Rochester, NY is $29.93, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $38.17 per hour, depending on experience, location, and employer.

What is risk adjustment?

Risk adjustment is a statistical process used in healthcare to account for the underlying health status and related costs of patients when comparing outcomes or setting payments. It helps ensure that providers or health plans are fairly compensated for caring for sicker patients and prevents them from being penalized for taking on higher-risk individuals. By considering factors such as age, gender, and chronic conditions, risk adjustment creates a more level playing field and promotes quality care across diverse populations.

How does a risk adjustment professional typically collaborate with other departments to ensure accurate data capture and reporting?

Risk Adjustment professionals frequently work cross-functionally with coding specialists, data analysts, and clinicians to ensure that patient diagnoses and health records are accurately documented and coded. This collaboration often involves regular meetings to review medical records, resolve discrepancies, and discuss updates in coding guidelines. By working closely with these teams, Risk Adjustment staff help ensure compliance with industry standards and maximize reimbursement accuracy, all while improving the quality of patient data. Strong communication and teamwork skills are essential in this role to effectively bridge gaps between clinical and administrative functions.

What are the key skills and qualifications needed to thrive as a risk adjustment specialist, and why are they important?

To thrive as a Risk Adjustment Specialist, you need a strong understanding of medical coding (ICD-10), healthcare regulations, and data analysis, often supported by a degree in health information management or a related field. Familiarity with coding software, EHR systems, and certifications such as CRC (Certified Risk Adjustment Coder) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately interpreting medical records and collaborating with providers. These skills and qualifications are essential to ensure accurate risk scoring, regulatory compliance, and proper reimbursement in the healthcare system.

What is the difference between Risk Adjustment vs Coding Specialist?

AspectRisk AdjustmentCoding Specialist
Required CredentialsCertifications like RHIA, RHIT, or CCS; knowledge of risk modelsCertifications such as CPC, CCS; coding accuracy skills
Work EnvironmentHealthcare organizations, insurance companies, risk adjustment teamsHospitals, clinics, medical billing departments
Industry UsageUsed to adjust payments based on patient risk profilesUsed to translate medical records into billing codes
Common Search/ComparisonOften compared for roles in healthcare finance and reimbursementCompared for medical coding and billing roles

Risk Adjustment professionals focus on analyzing patient data to ensure accurate risk scores for reimbursement, while Coding Specialists translate medical records into standardized codes for billing. Both roles require healthcare knowledge but serve different functions within the healthcare revenue cycle.

How long does it take to become a risk adjustment coder?

Becoming a risk adjustment coder typically requires completing a specialized training program or certification, which can take from a few months up to a year. Many professionals also pursue coding certifications such as CPC or CCS to enhance their skills and job prospects, with experience in medical coding and understanding of health records being important for success.

What are popular job titles related to Risk Adjustment jobs in Rochester, NY?

For Risk Adjustment jobs in Rochester, NY, the most frequently searched job titles are:

What job categories do people searching Risk Adjustment jobs in Rochester, NY look for?

The top searched job categories for Risk Adjustment jobs in Rochester, NY are:

Risk Adjustment jobs near you
Infographic showing various Risk Adjustment job openings in Rochester, NY as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, and 5% Contract. Highlights an 85% Physical, 5% Hybrid, and 10% Remote job distribution, with an average salary of $62,258 per year, or $29.9 per hour.

Risk Adjustment Quality Specialist

100 Lawrence Memorial Hospital

Rochester, NY • On-site

$70 - $90/hr

Other

Posted 4 days ago

Key responsibilities

  • Perform comprehensive reviews of patient medical records to assess documentation consistency and adequacy, identifying appropriate coding based on CMS HCC categories.

  • Manage the provider query process to clarify documentation and ensure completeness and accuracy of patient diagnoses, especially for chronic conditions.

  • Analyze performance data to identify trends, gaps, and opportunities for improvement.

Job description

Job Summary

The Risk Adjustment Quality Specialist coordinates and supports prospective, concurrent, and retrospective reviews to assist with patient care management. The role provides education and facilitates chart retrieval for Health Plan audits and reports. It requires a comprehensive understanding of Hierarchical Condition Categories (HCC) coding to accurately translate, input, extract, and validate medical record data. The specialist assists with monitoring quality program performance, including tracking, reporting, and implementation of best practices and program requirements.

Essential Job Responsibilities
  • Perform comprehensive reviews of patient medical records to assess documentation consistency and adequacy, identifying appropriate coding based on CMS HCC categories.
  • Monitor revenue opportunities related to value‑based care.
  • Manage the provider query process to clarify documentation and ensure completeness and accuracy of patient diagnoses, especially for chronic conditions.
  • Use evidence‑based practices to provide providers with targeted feedback and education on improving documentation and coding accuracy related to HCC.
  • Demonstrate analytical and problem‑solving ability to address barriers in receiving and validating accurate HCC information.
  • Analyze performance data to identify trends, gaps, and opportunities for improvement.
  • Maintain an intermediate to advanced understanding of claims processing procedures, state and federal regulations, and Medicare Part D requirements.
  • Utilize coding software to ensure compliance with Medicare, Medicaid, and other payer requirements.
  • Collaborate with medical staff to clarify documentation and support accurate coding and reimbursement.
  • Participate in audits, quality reviews and continuous‑improvement initiatives.
  • Educate staff on coding practices and HCC assignments.
  • Maintain compliance with policies, procedures, and continuing‑education requirements.
  • Perform additional duties as needed or assigned.
Job Qualifications
  • Minimum 3 years of experience in medical coding or risk adjustment with a focus on Hierarchical Condition Categories, value‑based care contracts, and accountable care organizations.
  • Strong knowledge of CMS risk‑adjustment and quality initiatives, including HCCs.
  • Completion of an AHIMA accredited certificate program (e.g., Certificate Coding Associate, Certificate Coding Specialist, Certified Professional Coder, Registered Health Information Technician, Registered Health Information Administrator) or credential from AAPC.
  • Preferred: Registered Nurse Associate or Bachelor’s Degree in Health Information Management.
  • Experience with 3M Coding Solution knowledge.
  • Hybrid work flexibility: must reside in Kansas or Missouri and attend on‑site meetings as scheduled.
Benefits
  • Competitive pay and advancement potential.
  • Tuition reimbursement to support continuing education.
  • Professional development and recognition.
  • Excellent benefits package.

We are an equal‑opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

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