Risk Adjustment Auditor Educator Salary in Pennsylvania

Risk Adjustment Auditor - Average Salary $90,858

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Risk Adjustment Manager - Average Salary $104,129

Manages an organization's risk adjustment processes to assess patient risk scores and ensure accurate reimbursement calculations. Utilizes patient health factors, their likely use of health care services, and the costs of those services to calculate payment adjustments, forecast revenue impacts, and identify coding gaps. Implements processes and standards to ensure accurate, timely, and compliant reporting to government agencies for determining risk adjustment payments. Monitors risk adjustment performance and leads and executes strategies to optimize financial performance while maintaining regulatory compliance. Requires a bachelor's degree. Typically reports to a director. Manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes.

Risk Adjustment Director - Average Salary $162,610

Plans and directs an organization's risk adjustment processes to assess patient risk scores and ensure accurate reimbursement calculations. Researches and promotes modeling and analysis frameworks to evaluate patient health factors and risk probability and calculate payment adjustments and revenue impacts. Develops processes and standards to ensure accurate, timely, and compliant reporting to government agencies for determining risk adjustment payments. Collaborates with senior leaders to develop and integrate strategies that optimize financial performance while maintaining regulatory compliance. Requires a bachelor's degree. Typically reports to senior management. Manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function.

Risk Adjustment Analyst - Average Salary $76,512

Analyzes healthcare data to assess patient risk scores and ensure accurate reimbursement calculations. Utilizes patient health factors, their likely use of health care services, and the costs of those services to calculate payment adjustments, forecast revenue impacts, and identify coding gaps. Reviews medical claims, encounter data, and electronic health records to ensure proper coding of diagnoses and accurate reporting to government healthcare programs. Prepares reports on risk adjustment performance and recommends strategies to optimize financial performance while maintaining regulatory compliance. Requires a bachelor's degree. Typically reports to a manager. Occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. Typically requires 2-4 years of related experience.

Risk Adjustment Coder - Average Salary $101,657

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