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Risk Adjustment Jobs (NOW HIRING)

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

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 ...

Strive Health

Risk Adjustment Coder

Denver, CO · Remote

$27.88 - $32.21/hr

What You'll Do The Coder, Risk Adjustment Coding is responsible for supporting the Strive operational and clinical team and partner Nephrologists by reviewing risk adjustment visits for appropriate ...

Boston Medical Center

Risk Adjustment Coder

$19.25 - $25.50/hr

The Risk Adjustment Coder determines the appropriate ICD10-CM diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment ...

HealthEdge

Director, Risk Adjustment Products

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. The Director will work closely with ...

ChenMed, LLC

Senior Director, Risk Adjustment

Miami, FL · On-site

The Senior Director, Risk Adjustment directs and oversees the centralized clinical operation services of Coding , Auditing, Data Analysis, & Quality Assurance of the Risk Adjustment COE that serves ...

Strive Health

Risk Adjustment Coder

Denver, CO · On-site +1

$19.25 - $25.75/hr

What You'll Do The Coder, Risk Adjustment Coding is responsible for supporting the Strive operational and clinical team and partner Nephrologists by reviewing risk adjustment visits for appropriate ...

HealthEdge

The Director, Risk Adjustment Products will lead the strategy, roadmap, and execution for the product portfolio focused on retrospective risk adjustment solutions. The Director will work closely with ...

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All JobsRisk Adjustment Jobs

Risk Adjustment information

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$14

$30

$74

How much do risk adjustment jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for risk adjustment in the United States is $30.34, according to ZipRecruiter salary data. Most workers in this role earn between $19.47 and $38.70 per hour, depending on experience, location, and employer.

What is risk adjustment in healthcare?

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.

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 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.
More about Risk Adjustment jobs
What cities are hiring for Risk Adjustment jobs? Cities with the most Risk Adjustment 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 jobs? States with the most job openings for Risk Adjustment jobs include:
What job categories do people searching Risk Adjustment jobs look for? The top searched job categories for Risk Adjustment jobs are:
Risk Adjustment jobs near you
Infographic showing various Risk Adjustment job openings in the United States as of June 2026, with employment types broken down into 1% Locum Tenens, 2% Internship, 71% Full Time, 10% Part Time, 15% Contract, and 1% Nights. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $63,100 per year, or $30.3 per hour.

Risk Adjustment Specialist

LSMA Management Inc

San Bernardino, CA • On-site

$30 - $34/hr

Full-time

Posted 28 days ago

Job description

Job Type
Full-time
Description
JOB SUMMARY
The Risk Adjustment Specialist - Coding Compliance supports the organization's delegated Risk Adjustment and Coding Compliance programs by performing specialized audit support, documentation review coordination, coding validation support, medical record analysis, and compliance activities to promote accurate and complete Hierarchical Condition Category (HCC) capture in accordance with Centers for Medicare & Medicaid Services (CMS), California Department of Managed Health Care (DMHC), National Committee for Quality Assurance (NCQA), Office of Inspector General (OIG), and contracted health plan requirements.
This role supports coding compliance oversight activities related to Medicare Advantage Risk Adjustment, Risk Adjustment Data Validation (RADV), provider documentation integrity, and coding accuracy initiatives. The position assists with identifying documentation gaps, monitoring coding compliance trends, coordinating audit preparation activities, and supporting provider education efforts to ensure accurate Risk Adjustment Factor (RAF) scoring and regulatory compliance.
The Risk Adjustment Specialist collaborates closely with Coding Compliance leadership, certified coders, providers, population health teams, utilization management, care management, quality improvement, and health plans to support compliant documentation and coding practices, audit readiness, and delegated risk adjustment program performance.
Requirements
MINIMUM & PREFERRED QUALIFICATIONS:
Education/Training
Minimum: High school diploma or GED equivalent required
Preferred: Associate's degree or higher in healthcare administration, public health, social services, or related field.
Experience
Minimum: At least one year of experience in one or more of the following areas: risk adjustment, coding compliance, medical record review, managed care, healthcare administration, managed care or MSO environment, medical office or provider operations.
Preferred: Experience supporting Medicare Advantage Risk Adjustment programs. Experience supporting CMS RADV audits or coding compliance audits. Experience in an MSO, IPA, health plan, delegated entity, or managed care environment. Experience working with electronic health records, coding software, or Risk Adjustment platforms.
Certification(s)
Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or other coding certification preferred.
Skills, Knowledge & Abilities
  • Knowledge of CMS Risk Adjustment methodology, HCC documentation requirements, and RAF score principles.
  • Understanding of Medicare Advantage Risk Adjustment, coding compliance, and documentation integrity requirements.
  • Familiarity with CMS RADV audit standards, DMHC regulatory requirements, NCQA standards, and delegated health plan oversight requirements.
  • Ability to identify documentation deficiencies, coding inconsistencies, compliance risks, and audit-related concerns.
  • Strong organizational, analytical, auditing, and data tracking skills with exceptional attention to detail and accuracy.
  • Ability to maintain accurate records, audit logs, compliance documentation, and reporting tools.
  • Proficiency with electronic health records, Risk Adjustment platforms, coding software, and Microsoft Office applications.
  • Strong verbal and written communication skills with the ability to communicate professionally with providers, coders, leadership, health plans, and interdisciplinary teams.
  • Ability to handle confidential and sensitive information in compliance with HIPAA and organizational policies.
  • Ability to manage multiple priorities, deadlines, and audit-related activities in a fast-paced managed care environment.
  • Ability to work independently while collaborating effectively within interdisciplinary operational and compliance teams.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:
The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Primarily sedentary work involving prolonged computer use. Occasional standing, walking, and local travel may be required. Ability to lift up to 20 pounds occasionally. Requires strong attention to detail, data analysis capability, and effective communication skills. Work is performed in an office or remote environment supporting electronic medical record and Risk Adjustment systems.
PAY RANGE
$30.00 - $34.00 / hourly
Salary Description
$30.00 - $34.00 / hourly

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