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Senior Risk Adjustment Auditor Jobs (NOW HIRING)

Imh

Risk Adjustment Coding Manager

Broomfield, CO

$38.55 - $59.49/hr

... auditing protocols to ensure internal and vendor compliance with all applicable regulations and risk adjustment data validation audits (RADV). Respond to and oversee CMS Risk Adjustment Data ...

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA

$137K - $184K/yr

Drives organizational risk adjustment policy, program standards, and performance, and maintains close partnerships with senior leaders across Clinical Operations, Analytics, Strategy, Technology ...

Molina Healthcare

VP, Risk Adjustment

Long Beach, CA · On-site +1

$137K - $184K/yr

Drives organizational risk adjustment policy, program standards, and performance, and maintains close partnerships with senior leaders across Clinical Operations, Analytics, Strategy, Technology ...

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$119.5K

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

As of Jun 29, 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 type of auditor gets paid the most?

Senior Risk Adjustment Auditors tend to earn higher salaries compared to entry-level or junior auditors due to their experience and specialized knowledge. Factors such as certifications, industry demand, and geographic location can also influence compensation levels for auditors in this field.

What is the average salary for a risk Adjustment Coder in the US?

The average salary for a Senior Risk Adjustment Auditor or Risk Adjustment Coder in the US typically ranges from $60,000 to $85,000 annually, depending on experience, certifications, and location. Professionals with specialized coding skills and certifications like CPC or CCS may earn higher salaries, especially in healthcare hubs or large 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.

What does a risk adjustment auditor do?

A risk adjustment auditor reviews healthcare claims and medical records to ensure accurate coding and documentation for risk adjustment purposes. They analyze data to verify that diagnoses are properly documented to support appropriate reimbursement and risk stratification, often using coding standards like ICD-10. This role requires attention to detail and knowledge of healthcare coding and compliance regulations.

Is an auditor a high paying job?

Senior Risk Adjustment Auditors typically earn higher salaries compared to entry-level auditors due to their specialized knowledge and experience. Compensation varies by industry, location, and certifications, but this role generally offers competitive pay within the auditing field. Advanced skills in data analysis and understanding of healthcare or insurance systems can also influence salary levels.
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Senior Risk Adjustment Auditor jobs near you
Infographic showing various Senior Risk Adjustment Auditor job openings in the United States as of June 2026, with employment types broken down into 99% Full Time, and 1% Part Time. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $90,973 per year, or $43.7 per hour.
HEALTH CODER - HCC & RISK ADJUSTMENT

HEALTH CODER - HCC & RISK ADJUSTMENT

NORTH EAST MEDICAL SERVICES

Burlingame, CA • Remote

$42.79 - $48.75/hr

Other

Posted 13 days ago

Job description

The Healthcare Coder plays a critical role in supporting accurate and compliant coding for NEMS MSO operations with a focus on Medicare Risk Adjustment (RA) programs. This position ensures accurate capture of Hierarchical Condition Category (HCC) coding and improves risk adjustment scores by conducting chart audits, providing provider education, and supporting clinical documentation improvement (CDI) initiatives. The Healthcare Coder will collaborate closely with providers, clinical staff, and leadership to improve coding accuracy and compliance, directly impacting the organization’s quality outcomes and financial performance.

ESSENTIAL JOB FUNCTIONS:

  • HCC Coding and Risk Adjustment (RA) Program Support
    • Perform comprehensive review of patient charts to identify and validate diagnosis codes in alignment with HCC and risk adjustment guidelines.
    • Ensure all coding adheres to CMS and ICD-10 guidelines, focusing on accuracy, completeness, and compliance.
    • Conduct prospective and retrospective chart audits to assess risk adjustment coding accuracy.
  • Provider Training and Clinical Documentation Improvement (CDI)
  • Develop and deliver provider education sessions and materials on best practices for clinical documentation and HCC/RA coding.
  • Provide one-on-one and group training to providers and clinical staff to improve documentation quality and accuracy.
  • Serve as a resource and subject matter expert on HCC, risk adjustment, and related coding standards.
  • Data Analysis and Reporting
    • Analyze coding data to identify trends, documentation gaps, and opportunities for improvement.
    • Generate reports and dashboards to track coding performance and documentation accuracy.
    • Collaborate with the Quality and Analytics teams to optimize risk adjustment processes.
  • Compliance and Continuous Improvement
    • Stay up to date with changes in coding, risk adjustment, and Medicare regulations.
    • Assist in the development and implementation of internal coding policies and procedures.
    • Participate in quality improvement initiatives related to coding and documentation.
    • Performs other job duties as required by manager/supervisor
  • Education & Certification:
    • BS/BA Degree in Health Science or General Education is required. 
    • Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent coding certification is required.
    • Additional CDI or auditing certifications (CCDS, CDEO, CPMA) are preferred.
  • Experience:
    • Minimum of 3 years of experience in medical coding with a focus on HCC, risk adjustment, and Medicare Advantage programs.
    • Experience in provider education, clinical documentation improvement (CDI), and chart audits.
    • Previous experience working in an IPA, managed care organization, or similar setting is strongly preferred.
  • Skills & Competencies:
    • Excellent communication, presentation, and interpersonal skills.
    • Strong understanding of CMS guidelines for Medicare Advantage and risk adjustment program.
    • Exceptional knowledge of ICD-10-CM coding and HCC risk adjustment coding methodologies.
    • Proficiency in electronic health records (EHR) and coding software.
    • Strong analytical and problem-solving skills.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluency in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This a full-time position. 

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