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Work From Home Medicare Risk Adjustment Jobs (NOW HIRING)

Experience in Medicare Advantage risk adjustment, RAF performance, clinical documentation ... Prior people leadership or matrixed team leadership experience. Work at Home Requirements: To ...

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Work From Home Medicare Enrollment Specialist Help Seniors. Make a Difference. Work From Home. $17.88/hour | Full-Time | September 8, 2026 - January 2027 Final Interviews Are Happening Now! Looking ...

Veteran-friendly

MRA Finance Senior Financial Analyst

$87K - $109K/yr

Experience in Medicare Advantage - risk adjustment or Stars Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service ...

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

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 ...

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 ...

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 ...

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 ...

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 ...

... from audit activities to address barriers, gaps, opportunities for improvement, and implement ... Ability to work cross-collaboratively in a highly matrixed environment, including ability to ...

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Work From Home Medicare Risk Adjustment information

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$12

$22

$40

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

As of Aug 9, 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?

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 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.
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:
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, 78% Full Time, 17% Part Time, and 4% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $46,633 per year, or $22.4 per hour.

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 2 days ago. Applications are no longer accepted.


Humana rating

8.0

Company rating: 8.0 out of 10

Based on 265 frontline employees who took The Breakroom Quiz

163rd of 304 rated insurance


Job description

Become a part of our caring community
We are seeking a Lead, Organic Risk Adjustment to build, operationalize, and scale our Organic Risk Adjustment program.
This is not a role focused primarily on setting strategy from the sidelines. We're looking for a builder and a doer someone who enjoys rolling up their sleeves, creating processes from the ground up, solving operational challenges, and driving results through execution. The ideal candidate is equally comfortable analyzing data, developing provider outreach plans, creating workflows, facilitating meetings, and following through on implementation.
This role will work closely with clinical, operational, and analytical partners to improve documentation accuracy, risk capture, and overall program performance. Success will come from the ability to turn ideas into action and build sustainable processes that create measurable impact.
Key Responsibilities
Program Development & Execution
  • Build and operationalize programs that improve organic risk adjustment performance.
  • Develop workflows, playbooks, provider engagement approaches, and reporting processes from the ground up.
  • Identify opportunities, create action plans, and personally drive implementation through completion.
  • Manage multiple initiatives simultaneously, ensuring deliverables are completed on time and produce measurable results.
  • Serve as the point person for day-to-day execution of Organic Risk Adjustment initiatives.

Provider & Operational Partnership
  • Partner directly with providers, practice leaders, operations teams, and clinical stakeholders to improve documentation and coding performance.
  • Create practical solutions that fit within existing clinical workflows.
  • Lead meetings, track action items, and ensure accountability across stakeholders.

Analytics & Performance Improvement
  • Analyze data to identify documentation and risk capture opportunities.
  • Translate insights into operational actions and measurable performance improvement.
  • Monitor outcomes and adjust programs based on results.

Use your skills to make an impact
Required Qualifications
  • Bachelor's degree or equivalent experience
  • 6+ years of related lead level experience
  • Experience in Medicare Advantage risk adjustment, RAF performance, clinical documentation improvement, coding, quality, or value-based care operations.
  • Demonstrated ability to lead cross-functional initiatives involving clinical, coding, analytics, quality, and operational stakeholders.
  • Experience developing provider education, documentation improvement strategies, and performance feedback processes.
  • Ability to analyze data trends, identify root causes, and translate insights into operational action plans.
  • Strong communication, facilitation, and stakeholder management skills.
  • Ability to manage multiple priorities in a fast-paced, highly regulated healthcare environment.

Preferred Qualifications
  • Experience leading organic or prospective risk adjustment programs.
  • Experience with provider-facing documentation workflows, EMR-based interventions, suspect condition programs, or point-of-care gap closure strategies.
  • Experience developing dashboards, executive reporting, or performance scorecards.
  • Knowledge of Medicare Advantage operations, quality programs, Stars, care management, and value-based payment models.
  • Prior people leadership or matrixed team leadership experience.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$115,200 - $158,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 08-04-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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About Humana

Sourced by ZipRecruiter

Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Louisville, KY, US

Year founded

1961

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