ZipRecruiter

Log In

2

Work From Home Medicare Risk Adjustment Jobs (NOW HIRING)

Greater Good Health

Risk Adjustment Coding Specialist

$80K - $95K/yr

... your work can make a lasting impact. The Role We are looking for a Risk Adjustment Coding ... The ideal candidate brings deep expertise in Medicare risk adjustment, a strong understanding of ...

Humana

Medical Coding Educator

$28 - $31.75/hr

Medicare Risk Adjustment knowledge * CRC -Certified Risk Adjustment Coder * Experience working with healthcare providers * Microsoft Office applications Additional Information Work at home - with ...

Humana

Medical Coding Educator

$28 - $31.75/hr

Medicare Risk Adjustment knowledge * CRC -Certified Risk Adjustment Coder * Experience working with healthcare providers * Microsoft Office applications Additional Information Work at home - with ...

Centene

Risk Adjustment Auditor Educator

$56K - $101K/yr

Work in conjunction with other departments to include Provider Relations, Quality as well as the ... Medicare risk adjustment (HCC Coding) Required Other experience in teaching, training or an ...

Oscar Health

Auditor, Risk Adjustment

Atlanta, GA · Remote

$82K - $108K/yr

While your daily work will be completed from your home office, occasional travel may be required ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Oscar Health

Auditor, Risk Adjustment

Tempe, AZ · Remote

$82K - $108K/yr

While your daily work will be completed from your home office, occasional travel may be required ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Humana

Risk Adjustment Admin Professional

$59K - $80K/yr

Team Collaboration: Working closely with retrieval and other internal groups. Work at Home ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Oscar Health

Auditor, Risk Adjustment

Dallas, TX · Remote

$82K - $108K/yr

While your daily work will be completed from your home office, occasional travel may be required ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Oscar Health

Auditor, Risk Adjustment

Miami, FL · Remote

$82K - $108K/yr

While your daily work will be completed from your home office, occasional travel may be required ... Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record ...

Humana

Risk Adjustment Admin Professional

$59K - $80K/yr

Team Collaboration: Working closely with retrieval and other internal groups. Work at Home ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

next page

Showing results 1-20

All Jobsremote JobsHealthcare JobsWork From Home Medicare Risk Adjustment Jobs

Work From Home Medicare Risk Adjustment information

See salary details

$12

$22

$40

How much do work from home medicare risk adjustment jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for work from home medicare risk adjustment in the United States is $22.42, according to ZipRecruiter salary data. Most workers in this role earn between $16.11 and $27.16 per hour, depending on experience, location, and employer.

What is a work from home Medicare risk adjustment job?

Work From Home Medicare Risk Adjustment jobs involve evaluating and documenting patient health records to ensure accurate risk scoring for Medicare Advantage plans. Professionals in these roles typically review medical charts, identify diagnoses, and ensure documentation meets regulatory requirements, all from a remote setting. These positions help healthcare organizations receive proper reimbursement from Medicare by accurately reflecting the health status of enrollees. Strong attention to detail, knowledge of ICD-10 coding, and experience with healthcare regulations are usually required.

What are the key skills and qualifications needed to thrive as a work from home Medicare risk adjustment specialist?

To excel as a Work From Home Medicare Risk Adjustment Specialist, you need a deep understanding of ICD-10 coding, risk adjustment methodologies, and relevant healthcare regulations, often supported by a coding certification such as CPC, CRC, or CCS. Familiarity with electronic health record (EHR) systems, coding software, and secure remote communication platforms is crucial. Strong attention to detail, self-motivation, and effective written communication help you accurately review and document patient data while working independently. These skills ensure accurate risk score calculations, regulatory compliance, and effective collaboration with healthcare teams from a remote setting.

What are some common challenges faced when working from home in a Medicare risk adjustment role, and how can they be addressed?

One of the main challenges in a work-from-home Medicare Risk Adjustment role is maintaining effective communication with team members and providers, as much of the collaboration is virtual. Staying updated on frequently changing CMS guidelines and documentation requirements can also be demanding. To address these challenges, it's important to establish regular check-ins with your team, utilize secure digital platforms for information sharing, and dedicate time each week to review new regulations. Staying organized and building strong virtual relationships with colleagues can help ensure accuracy and efficiency in risk adjustment processes.

What is the difference between Work From Home Medicare Risk Adjustment vs Work From Home Medicare Coding Specialist?

AspectWork From Home Medicare Risk AdjustmentWork From Home Medicare Coding Specialist
Required CredentialsCertifications in risk adjustment, healthcare complianceMedical coding certifications (CPC, CCS)
Work EnvironmentRemote, collaborative with healthcare teamsRemote, focused on coding documentation
Employer & Industry UsageHealth plans, Medicare Advantage organizationsHospitals, billing companies, healthcare providers
Common Search & ComparisonYesNo

Work From Home Medicare Risk Adjustment involves analyzing patient data to predict healthcare costs and ensure accurate reimbursements, requiring risk adjustment certifications. In contrast, Work From Home Medicare Coding Specialists focus on reviewing medical records and assigning appropriate codes, primarily needing coding certifications. Both roles are remote and essential in the healthcare industry but serve different functions within Medicare services.

More about Work From Home Medicare Risk Adjustment jobs

What cities are hiring for Work From Home Medicare Risk Adjustment jobs?

Cities with the most Work From Home Medicare Risk Adjustment job openings:

What states have the most Work From Home Medicare Risk Adjustment jobs?

States with the most job openings for Work From Home Medicare Risk Adjustment jobs include:

What job categories do people searching Work From Home Medicare Risk Adjustment jobs look for?

The top searched job categories for Work From Home Medicare Risk Adjustment jobs are:

Work From Home Medicare Risk Adjustment jobs near you
Infographic showing various Work From Home Medicare Risk Adjustment job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $46,633 per year, or $22.4 per hour.

Risk Adjustment Coding Specialist

Remote

Greater Good Health
Health Care and Social Assistance • 51 - 200 employees
Learn more about Greater Good Healthexternal

$80K - $95K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 18 days ago

Job description

Job Title: Risk Adjustment Coding Specialist
Job Location: Remote
Company Description
Greater Good Health is a fast-growing organization delivering care to older adults in access starved communities. Our innovative model is led by Nurse Practitioners and focused on outcomes, not volume—meaning we prioritize quality over quantity, spend more time with our patients, and are accountable for their health and well-being.
Whether through our own senior-focused primary care clinics or our suite of integrated clinical solutions for health plans and provider groups, we are making value-based care more accessible and more effective. We help reduce avoidable healthcare costs, improve clinical outcomes, and create a best-in-class patient experience.
If you're passionate about transforming healthcare and delivering meaningful care to those who need it most, Greater Good Health offers a purpose-driven, collaborative, and supportive environment where your work can make a lasting impact.
The Role
We are looking for a Risk Adjustment Coding Specialist to own retrospective CDI chart review and strengthen coding compliance, documentation accuracy, and risk adjustment optimization across our Medicare-focused primary care model. The ideal candidate brings deep expertise in Medicare risk adjustment, a strong understanding of outpatient clinical documentation, and the ability to translate complex coding requirements into practical guidance for clinical and revenue teams.
This role will work closely with leaders across Revenue Cycle, Clinical Operations amp; Clinical Performance to drive compliant, accurate, and optimized coding — resolving documentation and coding queries, closing retrospective review backlogs against CMS filing deadlines, and identifying opportunities to improve risk capture while reducing audit risk. The ability to communicate clearly with both clinical and non-clinical stakeholders is essential.
This role will ensure coding accuracy and consistency by helping design and formalize coding audit processes, documentation standards, and education materials. You will review charts, support query resolution, and provide insights into coding trends and regulatory changes that impact our operations.
The right person for this role will apply their extensive knowledge of Medicare risk adjustment coding to real-world clinical workflows, balancing compliance, operational efficiency, and scalability. This role offers meaningful autonomy, a focused but impactful scope, and the opportunity to directly strengthen our coding and compliance foundation as we continue to grow.
Responsibilities
  • Own retrospective CDI chart review for compliant, accurate and optimized coding
  • Design and execute formal coding audits to ensure CPT and diagnosis coding are compliant and fully supported by clinical documentation
  • Identify documentation gaps, education opportunities, and compliance concerns; support escalation and remediation efforts as needed
  • Partner with Revenue Cycle to support claim corrections, rebilling, and documentation follow-up
  • Assist with coding research for new or evolving CPTs and services, including documentation and billing requirements and Medicare reimbursement considerations
  • Support resolution of coding and documentation queries, collaborating with providers to amend documentation where appropriate
  • Develop coding and documentation education content for Nurse Practitioners and clinical teams, informed by audit findings and recurring themes
  • Build and maintain CDI worklists and audit trackers in Excel, including formula-driven flags for missed HCCs, recapture opportunities, and documentation gaps
  • Translate chart audit findings into structured Excel-based reporting (trend summaries, provider-level scorecards) for Revenue Cycle and Clinical Operations leadership
  • Support Care Services leadership with open condition management and risk adjustment workflows, including coaching and training as needed
  • Monitor and report on changes in the coding and risk adjustment landscape, including new, revised, or retired codes and regulatory guidance
  • Help formalize coding-related processes and documentation suitable for internal policies and compliance reference
Qualifications
Credentials amp; Certifications
  • Certified Risk Adjustment Coder (CRC or equivalent) required
  • CDI credential preferred (CDIP, CCDS, or equivalent) in addition to CRC
Clinical amp; Coding Experience
  • Medicare risk adjustment experience required
  • Demonstrated Clinical Documentation Improvement (CDI) experience, including query construction, provider education, and documentation gap remediation
  • Strong knowledge of ICD-10-CM coding guidelines, HCC models, and Medicare documentation requirements
  • Experience in outpatient clinic and/or primary care settings
  • Value-Based Care (VBC) experience
  • Experience supporting or participating in coding audits or compliance reviews preferred
Technical Skills
  • Proficiency in Excel, including pivot tables, VLOOKUP/XLOOKUP, conditional formatting, and data validation, for chart audit tracking and trend reporting
  • Experience building or maintaining audit worklists/trackers in Excel
Communication amp; Collaboration
  • Strong communication skills with the ability to translate coding guidance for clinical, operational, and finance stakeholders
  • Comfortable training and coaching providers on documentation and coding best practices, including delivering feedback on individual query patterns
What Will Make You Successful at GGH
  • If you “bring it” every day and are continually hungry to learn, share, and tackle challenges.
  • You thrive in an environment that champions learning, growth, agency, and autonomy. We support each team member to work at the “top of their license” and find fulfillment in their work.
  • We can trust that your words and actions align. We own our mistakes and share our learning with others. We think and act with consideration for people, time, rules, resources, ethics, and GGH’s success.
Perks and Benefits:
  • Competitive Compensation Package: We offer a competitive compensation package to recognize your valuable contributions and ensure your financial security.
  • Comprehensive Medical, Dental, and Vision Benefits: Take advantage of comprehensive healthcare coverage, including medical, dental, and vision benefits, to prioritize your health and well-being.Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) available.
  • Paid Time Off: Enjoy paid holidays, vacation time, and paid parental leave to maintain a healthy work-life balance and spend quality time with your loved ones.
  • 401K Program with Company Match: Plan for your future with our 401K program, featuring a company match, to help you save for retirement.
  • Monthly Phone/Internet Reimbursement: Stay connected with our monthly phone and internet reimbursement, ensuring you have the tools you need to excel in your role.
  • Comprehensive Life and AD amp;D Coverage: Enjoy peace of mind with 100% premiums covered by GGH for Basic Life and Accidental Death amp; Dismemberment (AD amp;D) insurance for full-time team members. Additionally, voluntary supplemental life insurance is offered at a discounted rate.
  • Short-Term Disability Coverage: Gain additional financial security with voluntary short-term disability (STD) coverage. This benefit provides a percentage of your salary during periods of illness or injury that prevent you from working for a set period of time.
  • Collaborative and Supportive Community: Join our collaborative and supportive GGH Nurse Practitioner Community, with dedicated care coordinators and MD advisors, to foster professional growth and success

Don’t check off every box in the requirements listed above? Please apply anyway! Studies have shown that marginalized communities - such as women, LGBTQ+ and people of color - are less likely to apply to jobs unless they meet every single qualification. GGH is dedicated to building an inclusive, diverse, equitable, and accessible workplace that fosters a sense of belonging – so if you’re excited about this role but your experience doesn’t align perfectly with every qualification in the job description, we encourage you to still consider applying. You may be just the right candidate for this role or another one of our openings!

Apply