Medicare Risk Adjustment Jobs

The Sr. Director, Risk Adjustment Data & Analytics role is a senior leadership position within Alignment Health's data operations team, dedicated to advancing Medicare Risk Adjustment programs. The individual oversees the end-to-end data ecosystem, ensuring integrity and compliance while leading a multidisciplinary team of analysts and engineers. Key responsibilities include driving analytical insights for executive decision-making, maintaining rigorous data governance for audit readiness, and partnering with finance and clinical stakeholders to optimize revenue and care outcomes. This position appeals to candidates seeking to lead high-impact work in a mission-driven organization that prioritizes senior care. The role offers significant growth opportunities within a fast-growing company and is available in a remote work arrangement.

The Medical Coding Educator 2 role supports the Medicare Risk Adjustment team by enhancing provider documentation and coding quality. Key responsibilities include arranging educational sessions for providers, analyzing coding audit data to identify error patterns, and creating data-driven presentations on compliance trends. The position requires collaboration with cross-functional teams to improve workflow processes and may involve occasional travel to provider offices. This opportunity appeals to candidates seeking to make a direct impact on healthcare outcomes within a caring community. The role offers a remote work arrangement with flexibility, supported by a company dedicated to putting health first and providing comprehensive wellness benefits.

The Director of Program Delivery role leads risk management and quality audit strategies within Humana's Risk Adjustment department. The position focuses on overseeing regulatory audits to ensure accurate data submission to federal agencies, driving operational excellence in coding quality, and developing analytics to minimize organizational risk. Key responsibilities include managing team goals and budgets, establishing compliance programs, and collaborating with cross-functional partners to enhance process improvement. This leadership opportunity appeals to professionals seeking to make a significant impact in healthcare while fostering a positive culture. The role is primarily remote with occasional travel required for meetings and training, offering a flexible work arrangement supported by a dedicated home office setup.

This management role within the Health Information Management department oversees Clinical Documentation Integrity and education across the Hartford HealthCare system. The position involves leading a team of specialists to manage audits, prevent revenue denials, and ensure regulatory compliance with Medicare and coding standards. Key responsibilities include developing staff education programs, analyzing performance metrics, and collaborating with revenue cycle leadership to improve data quality and patient safety reporting. The role appeals to experienced nursing professionals seeking career growth within a comprehensive healthcare network that values innovation and work-life balance. The position requires travel between facilities and offers the opportunity to influence system-wide clinical documentation strategies.

This remote role at Sedgwick involves analyzing complex workers' compensation claims to determine benefits, manage litigation, and negotiate settlements. Key responsibilities include calculating claim reserves, processing benefit payments, ensuring compliance with state regulations, and coordinating vendor referrals for investigations. The position appeals to professionals seeking a career within a globally recognized organization that prioritizes a caring culture, work-life balance, and professional growth. The role offers the opportunity to utilize advanced technology in a supportive environment while contributing to meaningful outcomes for individuals facing unexpected challenges.

This remote Claims Examiner role at Sedgwick focuses on adjudicating complex workers' compensation claims across multiple state jurisdictions. The position involves analyzing technically difficult cases, negotiating settlements, calculating reserves, and managing litigation processes to ensure timely resolutions. As a floater on a dedicated account, the role requires knowledge of 32 states and preferably holds a reciprocal license. The position is appealing due to Sedgwick's caring culture, extensive professional development opportunities, and flexible work arrangements that support work-life balance. Employees benefit from a collaborative global environment, comprehensive benefits, and the chance to contribute to meaningful solutions for clients worldwide.

This remote role at Sedgwick involves analyzing complex workers' compensation claims for California-based cases. The position requires managing high-exposure files, negotiating settlements, calculating reserves, and handling litigation processes while ensuring compliance with state regulations. Key responsibilities include coordinating vendor referrals, managing claim recoveries, and maintaining professional relationships with claimants and clients. The opportunity is appealing due to Sedgwick's caring culture, recognition as a top workplace, and the chance to work with advanced AI-enabled technology within a global organization. The role supports work-life balance and offers significant professional growth for experienced claims professionals.

The Senior Clinical Pharmacy Strategist role at PacificSource supports the Vice President of Pharmacy Services in executing enterprise cost of care strategies and quality initiatives. Key responsibilities include analyzing quality metrics to identify care gaps, designing clinical programs to improve STARS and HEDIS performance, and leading cross-functional teams to deploy integrated quality programs. This position offers the opportunity to drive meaningful impact on member outcomes and regulatory compliance within a collaborative environment. The role emphasizes data-driven decision-making and strategic planning to optimize medication use and enhance patient safety. It is based in an office setting with minimal travel, supporting a culture committed to diversity, innovation, and community improvement.

The Medicaid & ACA Manager role supports the strategic and operational execution of Medicaid and Affordable Care Act programs within a trusted Kansas-based healthcare organization. Key responsibilities include building detailed workplans, monitoring performance indicators like medical loss ratios and enrollment trends, and leading cross-functional coordination to ensure regulatory compliance and financial objectives are met. The position appeals to candidates seeking a dynamic environment with a strong emphasis on family, professional growth through training programs, and a collaborative culture that values inclusivity. This full-time position offers flexible work arrangements, including remote, hybrid, or onsite options, for individuals residing in or willing to relocate to Kansas or Missouri.

The Associate Director, Coding Education role leads the clinical coding curriculum strategy within the CenterWell Primary Care Organization, supporting a caring community focused on senior wellness. Key responsibilities include designing and deploying training programs for providers, aligning education strategies with organizational risk adjustment goals, and managing a team of regional coding educators. The position requires collaborating with clinical excellence and operations teams to ensure training quality and data-driven improvements. This opportunity appeals to candidates seeking to make a significant impact in value-based care while working in a collaborative, matrixed environment. The role offers hybrid flexibility with limited regional travel and the chance to mentor a distributed team of professionals.

The Inpatient Coding Manager role leads the coding department within a top-ranked non-profit health system, reporting to the Director of Revenue Integrity. Key responsibilities include managing daily operations of coding teams, developing department policies and training materials, and ensuring compliance with federal regulations and accurate billing practices. The position also involves educating providers on documentation standards and collaborating with clinical quality teams to capture outcomes data. This opportunity appeals to professionals seeking to drive revenue integrity in a community-focused environment with a reputation for excellence. The role is based on-site in Fayetteville, Arkansas, within a standard office setting.

The Senior Quality Specialist role at Tapestry 360 Health focuses on driving quality improvement and value-based care initiatives within a mission-driven Federally Qualified Health Center. Key responsibilities include analyzing clinical performance data to close care gaps, coordinating population health outreach programs, and developing standardized workflows to enhance operational efficiency. The position requires close collaboration with clinical and administrative teams to translate metrics into actionable strategies that improve patient outcomes. This opportunity appeals to professionals seeking to make a tangible community impact while working in a supportive environment that offers comprehensive benefits, including retirement plans and eligibility for Public Service Loan Forgiveness. The role is based in a professional office setting with occasional travel for meetings and community events.

This senior Data Architect role focuses on designing and maintaining enterprise-scale data architectures specifically for Medicaid claims, eligibility, and care management within the healthcare sector. The position involves establishing data ingestion frameworks, defining governance standards to ensure HIPAA and CMS compliance, and leading cloud-based modernization efforts using platforms like Snowflake or Azure. Key responsibilities include translating complex regulatory requirements into scalable technical solutions, mentoring data engineering teams, and ensuring data quality across high-volume pipelines. The role is appealing for its opportunity to shape critical healthcare infrastructure while working in a fully remote environment with a collaborative culture that values professional growth and technical leadership.

This senior underwriting role involves leading the establishment of a new Allied Healthcare division within an international insurance company. The position focuses on assessing and pricing professional liability coverage for diverse medical entities, including surgical centers, hospices, and physician groups. Key responsibilities include managing the underwriting team through hiring and coaching, developing the business book, and collaborating directly with executive leadership. The role offers a significant growth opportunity within a stable organization that prioritizes long-term employee development. While based in New Britain, Connecticut, remote work arrangements may be available, and the position emphasizes a collaborative culture with comprehensive benefits.

This senior underwriting role involves leading the establishment of a new Allied Healthcare division within an international insurance company based in Peoria, Illinois. The position focuses on assessing and pricing professional liability coverage for diverse medical entities, including surgery centers, hospices, and physician groups. Key responsibilities include developing the business book, managing the underwriting team through hiring and coaching, and collaborating directly with executive leadership. The role offers significant growth potential as the primary leader in a newly formed program. It provides remote work flexibility and emphasizes a long-term culture with opportunities for professional development and team building.

The Plant Operator role within Archaea Energy's Gas & Low Carbon Energy team focuses on the safe and efficient operation of landfill gas-to-energy facilities. Key responsibilities include executing control of work processes, performing maintenance and troubleshooting on engine generator sets, and monitoring plant performance to mitigate operational risks. The position offers the appeal of contributing to sustainable energy solutions within a safety-first culture that emphasizes professional growth and team collaboration. This full-time, on-site position requires availability for rotating shifts and involves up to 25% travel.

This General Liability Claims Consultant role within The Hartford Global Specialty Claims Division handles complex bodily injury and property damage claims from inception to resolution. Key responsibilities include conducting investigations, making coverage determinations, managing litigation and counsel, and setting financial reserves for high-value cases. The position appeals to professionals seeking a mission-driven environment where they can shape the future of insurance while developing strategic resolution skills. The role offers a flexible hybrid or remote work arrangement, with in-office expectations varying by location, and provides opportunities to contribute to broader enterprise goals and product development initiatives.

The Business Information Security Officer role serves as a strategic liaison within the Information Security organization at LexisNexis Legal & Professional, bridging the gap between security protocols and business innovation. The position focuses on embedding security-by-design principles into the product lifecycle, translating complex risk data into actionable insights for product and executive leaders, and fostering collaboration across cross-functional teams. This opportunity appeals to professionals from diverse backgrounds, including product, strategy, or operations, who excel at relationship-building and influencing decision-making. The role offers significant career growth through mentorship and training in core security concepts, supported by a culture that prioritizes work-life balance, flexible scheduling, and comprehensive wellbeing initiatives.

This part-time Licensed Practical Nurse role operates within a long-term care facility, focusing on delivering holistic nursing care to residents. The position involves conducting daily clinical rounds, managing medication administration, and updating resident care plans in collaboration with healthcare providers. Key responsibilities include supervising nursing staff, coordinating with interdisciplinary teams, and ensuring compliance with safety and sanitation regulations. The role appeals to candidates seeking to make a meaningful impact on elderly care while working in a supportive environment that values professional development and teamwork. The position requires on-site presence and involves physical tasks such as lifting and moving freely throughout the facility.

This Registered Dietitian role supports an interdisciplinary healthcare team within a dialysis facility, focusing on optimizing nutritional status and clinical outcomes for in-center and home patients. Key responsibilities include conducting comprehensive nutritional assessments, developing individualized care plans, and providing specialized education on kidney disease management and diet. The position requires ongoing monitoring of lab results, collaboration on treatment adjustments, and maintaining accurate medical documentation. The role appeals to professionals seeking to make a direct impact on patient health through evidence-based nutrition therapy within a supportive environment that values continuous learning and quality improvement. The position involves travel between assigned facilities and requires a valid dietetic registration and state licensure.

This remote Junior Staff Accountant role supports the accounting department by maintaining General Ledger accounts and ensuring compliance with GAAP. Key responsibilities include processing monthly journal entries, reconciling fixed asset accounts, handling accounts receivable write-offs, and assisting with budget preparation and audit support. The position appeals to candidates seeking a stable career within a certified Great Place to Work company known for its supportive culture and strong values. The role offers opportunities for professional growth and advancement within a dynamic, fast-paced environment while providing access to a comprehensive benefits package.

The Manager of Health Information Management leads the HIM department at Campbell County Health, a comprehensive healthcare system in northeast Wyoming. This on-site role in Gillette oversees coding, clinical documentation improvement, release of information, and medical record integrity while serving as the Facility Privacy Officer. Key responsibilities include establishing strategic goals, ensuring regulatory compliance across multiple facilities, managing budgets, and supervising a diverse team of coders and specialists. The position appeals to candidates seeking leadership opportunities within a collaborative community-focused organization that offers robust benefits, including generous paid time off, comprehensive health coverage, and an employer-matched retirement plan.

The Manager of Health Information Management leads the strategic direction and daily operations of the HIM department at Campbell County Health, a comprehensive healthcare system in northeast Wyoming. This on-site role oversees coding, clinical documentation improvement, release of information, and medical record integrity while serving as the Facility Privacy Officer. Key responsibilities include managing diverse teams, ensuring compliance with federal and state regulations, developing departmental budgets, and collaborating with hospital leadership to improve performance outcomes. The position offers the opportunity to lead a multi-facility organization with a supportive culture that provides generous benefits, including paid time off, health insurance, and on-site childcare.

The Site EHS Manager III role serves as a strategic leader within Amazon's Workplace Health & Safety team, dedicated to establishing safety excellence across operations. The position involves orchestrating the global safety program, partnering with operations leadership to integrate risk reduction into daily workflows, and leading comprehensive risk assessments using data-driven insights. Key responsibilities include developing and mentoring a high-performing team of safety professionals, conducting site audits, and driving continuous improvement initiatives to enhance operational efficiency. This position is appealing for its opportunity to act as a catalyst for cultural change and protect thousands of associates in a dynamic, fast-paced environment. The role requires on-site presence at a distribution center, involving physical activity and interaction with diverse teams, while offering a collaborative culture focused on innovation and employee well-being.

This Site EHS Manager III role at Amazon focuses on leading workplace health and safety initiatives to support the company's mission of becoming the safest place to work. The position involves partnering with operations leadership to integrate safety into daily workflows, conducting comprehensive risk assessments, and transforming safety data into actionable strategies. Key responsibilities include managing a team of safety professionals, overseeing training programs, and driving continuous improvement through data analytics and lean principles. The role is appealing for its opportunity to influence culture and protect thousands of associates while working in a dynamic, fast-paced environment. The position is based in Staten Island and requires on-site presence with physical capabilities to navigate various operational conditions.