Risk Adjustment Consultant - $43. .08 per hour

About the Role

This opportunity is for a Risk Adjustment Consultant supporting Programs of All-Inclusive Care for the Elderly (PACE) through accurate diagnosis capture, compliant documentation, and strong revenue integrity practices. The role is embedded within a specialized risk adjustment team and works closely with clinical staff, project managers, and client leadership. This position combines hands-on medical coding with client-facing consulting, education, and workflow optimization. The consultant is responsible for improving documentation quality, identifying coding gaps, supporting compliance with CMS and HCC guidelines, and helping clients strengthen operational performance. This role is ideal for an experienced coding professional who enjoys working directly with clients, delivering training, and driving measurable improvements across risk adjustment operations.

Compensation

What You’ll Do

• Conduct detailed and accurate medical record reviews using ICD-10-CM Official Guidelines, AHA Coding Clinic guidance, and internal coding guidelines.
• Complete Pre-Encounter Preparation (PEP) and concurrent coding workflows with a high level of accuracy and efficiency.
• Monitor analytics dashboards to identify coding and documentation gaps, performance trends, and opportunities for improvement.
• Ensure compliance with CMS risk adjustment requirements, HCC frameworks, and RADV audit standards.
• Maintain a coding accuracy score of 95% or higher through consistent quality and guideline adherence.
• Serve as the primary contact for assigned PACE clients, providing ongoing risk adjustment guidance and operational support.
• Partner with providers to improve documentation quality, completeness, and coding accuracy.
• Deliver structured feedback, one-on-one coaching, and documentation improvement strategies.
• Conduct monthly metric reviews with clients to evaluate results, identify gaps, and recommend action plans.
• Lead onsite training during onboarding, go-live, and optimization phases, including Risk Adjustment 101, PEP training, and provider coaching.
• Host virtual training sessions focused on provider workflows, documentation excellence, analytics dashboards, and coding refreshers.
• Conduct biweekly office hours and ensure sessions are recorded and available for asynchronous learning.
• Adapt training content for different clinical roles and workflows using strong presentation and facilitation skills.
• Coordinate with project managers and clinical leadership to align training agendas with client goals and implementation timelines.
• Develop and execute customized onboarding plans for each client.
• Coordinate risk adjustment deliverables and timelines across platform teams and service lines.
• Support workflow design and process optimization by recommending improvements based on client feedback, quality reviews, and data insights.
• Contribute to system enhancement and configuration recommendations that strengthen documentation and coding workflows.
• Support accurate risk adjustment data submissions to CMS and other regulatory entities.
• Participate in internal quality reviews, audits, and coding accuracy checks.
• Maintain detailed documentation of coding decisions, audit notes, and workflow recommendations.

Qualifications

• Hold all required certifications:

CPC, CCS, RHIT, and CRC .

• Have at least 5 years of medical coding experience with a focus on risk adjustment.
• Have a high school diploma; an associate’s or bachelor’s degree is preferred.
• Possess deep knowledge of CMS-HCC models, RAF scoring, and risk adjustment methodologies.
• Be proficient with EMR/EHR systems, coding platforms, and natural language processing tools.
• Demonstrate strong analytical skills and the ability to interpret trends and turn findings into actionable recommendations.
• Have excellent written and verbal communication skills and be comfortable delivering training both onsite and virtually.
• Be able to work independently in a remote environment while managing deadlines and client expectations.
• Be willing and able to travel to support client go-live activities.

Preferred Qualifications

• Experience supporting PACE programs or senior care populations.
• Familiarity with IRIS platform workflows and consulting operations.
• Experience in clinical documentation improvement and interdisciplinary collaboration.

Annual Salary: $90,000 - $100,000 per year The expected target compensation is near the midpoint of the range, although final pay will depend on experience, qualifications, skills, and organizationa Apply tot his job Apply To this Job