A risk adjustment coder reviews medical records and assigns the ICD-10-CM diagnosis codes that support risk-adjusted payment systems such as Medicare Advantage and ACA plans.
Medicare Advantage plans are paid based on the diagnoses they submit for their enrollees, so the job is capturing each patient's complete health status accurately and supporting it under audit.
Employers include insurance companies, risk adjustment vendors and other employers AAPC lists outside direct patient care, and AAPC's CRC credential certifies the specialty.
What risk adjustment coders do
Risk adjustment coding is the diagnosis-focused branch of medical coding: applying ICD-10-CM diagnosis codes to capture a patient's complete health status in value-based care models, which is what AAPC says its Certified Risk Adjustment Coder (CRC) credential validates.
The Bureau of Labor Statistics counts medical coders within medical records specialists (SOC 29-2072), an occupation it defines as workers who compile, process and maintain patient files and may classify patient information into the healthcare coding system.
Coders, in BLS's description, assign diagnosis and procedure codes for patient care, population health statistics and billing purposes.
What separates the specialty is what the diagnoses are for.
CMS says Medicare Advantage plans receive risk-adjusted payments based on the diagnoses they submit for enrollees, with higher payments for patients with more serious or chronic conditions.
Federal regulation at 42 CFR 422.308(c) directs CMS to adjust Medicare Advantage payments for health status using a risk factor based on submitted risk adjustment data.
The inputs are tightly defined.
CMS's Medicare Managed Care Manual (chapter 7) says risk adjustment diagnoses must be documented in the medical record, result from a face-to-face visit, and be coded per ICD-10-CM guidelines.
The same manual limits the acceptable data sources to hospital inpatient facilities, hospital outpatient facilities and physicians.
Day to day, that means reading charts from those settings and checking that every reported diagnosis is documented and supportable.
AAPC describes what its CRC credential validates as applying ICD-10-CM diagnosis codes to capture a patient's complete health status in value-based care models.
Like other medical records specialists, risk adjustment coders review records for timeliness, completeness and accuracy, and they clarify diagnoses with healthcare workers such as registered nurses when information is missing or unclear.
The model behind the work is the CMS-HCC risk adjustment model.
CMS's 2027 Rate Announcement, issued April 6, 2026, keeps the 2024 CMS-HCC model — the version the industry calls V28 — in place for 2027 for non-PACE Medicare Advantage organizations.
“HCC” is short for Hierarchical Condition Categories — the term that gives the CMS-HCC model the second half of its name.
Who employs risk adjustment coders
AAPC lists risk adjustment vendors among the non-patient-care employers of coders and billers, alongside insurance companies, billing companies, software and durable medical equipment vendors, government agencies, educational institutions, healthcare consulting firms and some law offices.
Insurance companies are on that list, and Medicare Advantage plans receive risk-adjusted payments based on the diagnoses they submit for their enrollees, which is why health plans sit near the center of this specialty.
Federal wage data shows where the wider occupation sits.
In the BLS OEWS survey for May 2025, insurance carriers and related activities employed 6,150 medical records specialists at a $62,040 median annual wage.
Across all industries, BLS reported the 2025 employer mix for medical records specialists as hospitals (28%), offices of physicians (18%), professional, scientific and technical services (10%), administrative and support services (8%) and management of companies (7%).
The audit side employs coders too.
In May 2025 CMS said it would audit all eligible Medicare Advantage contracts for each payment year in newly initiated audits and expedite audits for payment years 2018 through 2024.
CMS said technology would let it expand RADV from “~60 MA plans a year” to “all eligible MA plans” in newly initiated audits.
CMS also said it would grow its own team of medical coders from 40 to approximately 2,000 by September 1, 2025 to manually verify diagnoses flagged by technology — an announced target, not a confirmed headcount.
Scale context helps when you read demand claims.
CMS projected Medicare Advantage enrollment of 34 million for 2026, down from 34.9 million in 2025.
Technology is part of the picture as well: in AHIMA and NORC's 2023 workforce survey, 12% of respondents whose organizations use AI and machine learning reported using AI risk adjustment tools.
Open roles are listed on the risk adjustment coder jobs board.
Retrospective vs prospective risk adjustment work
Neither term is defined in the CMS and AAPC sources this research relied on, so read how each employer describes a retrospective or prospective project.
What the federal sources do set is the calendar: CMS's manual describes the risk adjustment data collection period as generally the calendar year before the payment year.
After submission, CMS checks the result.
CMS conducts Risk Adjustment Data Validation (RADV) audits to confirm that the diagnoses used for Medicare Advantage payment are supported by medical records, and it may collect overpayments for unsupported diagnoses after the final data submission deadline.
Those audits reach back years: CMS's May 2025 announcement expedites audits covering payment years 2018 through 2024.
Chart review by Medicare Advantage organizations draws federal scrutiny.
In the OIG's 2019 analysis, over 99% of the chart reviews examined added diagnoses, and OIG said the resulting payments raise concerns.
For 2027, CMS's Rate Announcement finalized excluding diagnoses from unlinked chart review records from risk scores, with an exception for beneficiaries who switch from one Medicare Advantage organization to another.
Whichever mode a project uses, the manual's requirement attaches to what gets submitted: CMS requires that all diagnosis codes submitted be documented in the medical record, documented as a result of a face-to-face visit, and coded per ICD-10-CM guidelines.
How a given employer splits its projects between the two modes was not quantified in this research, so treat any firm's mix as its own.
Credentials: the CRC
AAPC names the CRC — Certified Risk Adjustment Coder — among its four main core coding certifications, alongside the CPC, COC and CIC, with the CPB for billers.
The credential validates risk adjustment coding: applying ICD-10-CM diagnosis codes to capture a patient's complete health status in value-based care models.
AAPC describes the CRC's coverage as ICD-10-CM coding of chronic and complex conditions, HCCs, and risk adjustment payment systems such as Medicare Advantage and ACA plans.
AAPC also positions the CRC for beginners, saying it is aimed, among others, at new entrants to medical coding who want to start their careers in risk adjustment and value-based care.
On the requirement side, BLS says medical records specialists typically need a postsecondary certificate to enter the occupation, although some qualify with a high school diploma and others need an associate's or bachelor's degree.
BLS adds that certification may be required or preferred, and that employers may prefer certified applicants or expect certification shortly after hire.
The CRC is a professional credential from AAPC, not a license, and the requirement that matters in practice is each employer's.
Credential rules change, so confirm the current CRC eligibility, exam delivery, cost and renewal requirements with AAPC before you register.
Confirm credential details with AAPC
Remote risk adjustment coding work
The work is reading records and assigning codes, not hands-on patient care.
BLS calls medical records specialist work one of the few health-related occupations with no direct hands-on patient care.
In AAPC's 2025 salary survey, 64.8% of respondents reported working fully remote, 19.8% fully on-site and 15.4% hybrid.
Before 2020, only 30-33% of its survey respondents worked remotely, and AAPC notes remote work used to be reserved for the most experienced employees.
Read those numbers with their scope attached: they describe AAPC's survey respondents — a self-selected group of mostly members — not the share of job postings that are remote, which this research did not find quantified anywhere.
Employer type shapes the setup: AAPC lists vendors, insurers, government agencies and consulting firms among the employers not related to direct patient care.
Each posting sets its own requirements, so check them individually.
Risk adjustment coder pay
Two sources bracket the pay picture, and they measure different things.
BLS's closest group for coders is medical records specialists (SOC 29-2072), an occupation that also includes records staff who do not code; its median annual wage was $51,140 in May 2025.
AAPC's 2026 salary report puts the specialty higher: CRC holders averaged $74,629 in 2025, up 18.6% from $62,916 in 2020, and certified medical records specialists averaged $67,260 against $55,721 for non-certified ones — 20.7% more.
The AAPC figures are survey averages of self-selected, mostly member respondents — not BLS data and not a representative sample of all workers.
For the full BLS tables by state and metro area, see the coder salary page.
Career information, not coding, billing-compliance, legal or tax advice; confirm credential details with AAPC and Medicare Advantage payment rules with CMS.