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Work From Home Medicare Risk Adjustment Jobs (NOW HIRING)

Honest Health

Sr. Risk Adjustment Auditor

$82K - $101K/yr

For us, that's just an Honest day's work. Your Role The Risk Adjustment Auditor is a key ... Direct experience with Medicare Advantage (Part C) risk adjustment models and HCC coding required

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 ...

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

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 ...

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 ...

TEKsystems

Risk Adjustment Coding Auditor

Phoenix, AZ · Remote

$32 - $37/hr

Knowledge of Medicare, Medicaid, and ACA Commercial risk adjustment models. * Ability to interpret ... Ability to work independently while collaborating with cross-functional teams. * Commitment to ...

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All JobsMedicare Risk Adjustment JobsWork From Home Medicare Risk Adjustment Jobs

Work From Home Medicare Risk Adjustment information

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

As of Jul 30, 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 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.

What are the key skills and qualifications needed to thrive as a Work From Home Medicare Risk Adjustment Specialist, and why are they important?

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 are Work From Home Medicare Risk Adjustment jobs?

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.
More about Work From Home Medicare Risk Adjustment jobs
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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 July 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $46,633 per year, or $22.4 per hour.

HEALTH CODER - HCC & RISK ADJUSTMENT

NORTH EAST MEDICAL SERVICES

Burlingame, CA • Remote

$42.79 - $48.75/hr

Other

Re-posted 14 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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