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Senior Risk Adjustment Auditor Jobs (NOW HIRING)

Strive Health

Risk Adjustment Coder

Denver, CO · On-site

$19.25 - $25.75/hr

What You'll Do The Coder, Risk Adjustment Coding is responsible for supporting the Strive ... From AAPC or AHIMA. * 5+ years combined of related education, coding/auditing experience, or ...

Medica

Risk Adjustment Healthcare Analyst

Minnetonka, MN · On-site

$90K - $155K/yr

The Risk Adjustment Healthcare Analyst (P3) is a senior-level individual contributor responsible for delivering complex, high-impact analytics and reporting that supports the organization's Risk ...

Medica

Risk Adjustment Healthcare Analyst

Madison, WI

$90K - $155K/yr

The Risk Adjustment Healthcare Analyst (P3) is a senior-level individual contributor responsible for delivering complex, high-impact analytics and reporting that supports the organization's Risk ...

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How much do senior risk adjustment auditor jobs pay per year?

As of Jun 6, 2026, the average yearly pay for senior risk adjustment auditor in the United States is $90,973.00, according to ZipRecruiter salary data. Most workers in this role earn between $81,000.00 and $99,500.00 per year, depending on experience, location, and employer.

What are Senior Risk Adjustment Auditors?

Senior Risk Adjustment Auditors are experienced professionals who review medical records and data to ensure accurate coding and documentation for risk adjustment purposes, primarily in healthcare settings. They help organizations comply with government regulations and maximize appropriate reimbursement by identifying and correcting coding errors or gaps. Their role involves analyzing patient data, collaborating with coding teams, and providing feedback or training to improve documentation practices. Senior auditors often have advanced knowledge of ICD-10-CM coding, risk adjustment models (such as HCC), and auditing standards. Their expertise helps healthcare organizations maintain compliance and optimize financial performance.

How does a Senior Risk Adjustment Auditor typically collaborate with coding teams and healthcare providers to ensure accurate documentation and coding?

A Senior Risk Adjustment Auditor often works closely with medical coding teams and healthcare providers to review patient records for accuracy and compliance with risk adjustment guidelines. This collaboration may involve providing feedback on documentation quality, clarifying coding ambiguities, and offering training or guidance on best practices. Regular meetings and audits help ensure that everyone is aligned with current regulations and organizational standards. Effective communication and teamwork are essential to maintain high-quality, compliant coding that supports proper reimbursement and patient care.

What are the key skills and qualifications needed to thrive as a Senior Risk Adjustment Auditor, and why are they important?

To thrive as a Senior Risk Adjustment Auditor, you need deep expertise in medical coding (ICD-10-CM), risk adjustment methodologies, and a background in healthcare compliance, typically supported by certifications such as CRC, CPC, or CCS-P. Familiarity with auditing platforms, data analysis tools, and electronic medical records systems is crucial. Exceptional attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and effectively collaborate with providers. These competencies ensure accurate risk scoring, regulatory compliance, and optimal reimbursement for healthcare organizations.

What is the difference between Senior Risk Adjustment Auditor vs Risk Adjustment Auditor?

AspectSenior Risk Adjustment AuditorRisk Adjustment Auditor
CertificationsCPMA, RAC, or similarCPMA, RAC, or similar
Work EnvironmentHealthcare organizations, insurance companies, consulting firmsHealthcare providers, insurance companies, auditing firms
Job ResponsibilitiesLeading audits, mentoring, complex data analysisPerforming audits, data review, compliance checks

Both roles require similar certifications and work in healthcare or insurance settings. The Senior Risk Adjustment Auditor typically handles more complex audits, provides mentorship, and takes on leadership tasks, whereas the Risk Adjustment Auditor focuses on executing audits and data analysis. The senior role involves greater responsibility and expertise, often leading to career advancement in risk adjustment auditing.

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Senior Risk Adjustment Auditor jobs near you

Manager, Risk Adjustment

Central Mass Health LLC

Worcester, MA • On-site

$90K/yr

Full-time

Posted 20 days ago

Job description

Mass Advantage is a Medicare Advantage health plan, located in the heart of Worcester County, headquartered in Worcester MA. Mass Advantage is owned and designed by UMass Memorial Health providers with their patients' needs in mind.
We are looking for a Manager of Risk Managment to oversee Mass Advantages's full suite of Risk Adjustment activities. This position is responsible for the strategy, execution and performance of Medicare risk adjustment programs, infrastructure and systems to meet business objectives, revenue expectations, management of external vendors, interaction with Providers, regulatory audits, and compliance with CMS regulations. The Manager of Risk Management is also responsible for analysis, projections, and assessment of Medicare revenue initiatives for senior products; leading and coordinating enterprise risk adjustment initiatives, working with the necessary areas of Mass Advantage and UMass Memorial Health Operations as well as vendor partners.
Essential Duties and Responsibilities:
Program Strategy & Execution
  • Own end-to-end RA strategy across prospective (point-of-care capture, suspecting, provider workflows) and retrospective (chart review, coding validation) programs, ensuring complete, accurate, and compliant HCC documentation under the applicable CMS-HCC model (including V24 -V28 transition management).
  • Evaluate current vendor performance, renegotiating or sunsetting SOWs where internal capability is superior.
  • Serve as the plan-side counterpart to UMMH CDI, HIM, and Coding leadership, coordinating with the CMO's office to embed documentation workflows into Epic-based clinical practice rather than layered on top of it.
  • Partner with Network and Clinical Services to design provider-facing education, scorecards, and incentive structures that drive documentation accuracy without creating coding-driven behavior.
  • Develop provider-level performance reporting that is transparent, defensible, and actionable.

RADV, Audit & Compliance
  • Lead RADV audit readiness and response, including medical record retrieval, validation, submission strategy, and cross-functional coordination with Legal, Compliance, and Finance to mitigate financial and compliance risk.
  • Maintain a comprehensive QA program covering RADV, OIG, and internal audits - monitoring the work of internal coders, contracted vendors, and provider documentation alike.
  • Own encounter data integrity, including EDPS submission accuracy, RAPS/EDPS reconciliation, and error resolution.

Analytics, Finance & Bid Support
  • Build and maintain the RA analytics layer - dashboards, KPIs, and provider/member-level reporting that drive continuous improvement in risk score accuracy, coding yield, and program ROI.
  • Partner with Actuarial and Finance on bid development, producing defensible risk score projections, trend analysis, and revenue assumptions grounded in population severity and program performance.
  • Communicate results to executive and board audiences through clear reports, dashboards, and presentations.

Program & Team Leadership
  • Set departmental goals, budgets, and tactical plans aligned with enterprise strategy and financial targets.
  • Other duties may be assigned as needed.

* Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Requirements
  • Bachelor's degree in a relevant field; Master's (MBA, MHA, MPH) preferred.
  • Registered Nurse (RN) desired.
  • CRC (Certified Risk Adjustment Coder), CPC, or CCS certification preferred.
  • 7+ years in Medicare Advantage risk adjustment, with at least 3 years in a plan-side role (not solely provider-side or vendor-side).
  • Direct, hands-on RADV experience - working fluency with the CMS-HCC model, including the V24-V28 transition and its financial implications.
  • Demonstrated experience managing or transitioning RA vendors (coding, chart retrieval, in-home assessment).
  • Strong analytical skills: able to interrogate data directly in SQL, Power BI, or Tableau, or to spec analytics requirements with precision.+
  • Strong Microsoft Office skills (Word, Outlook, Excel and PP).

Salary Description
Starting at $90K

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