Risk Adjustment Consultant

About reputed company

reputed company is the only end-to-end ecosystem built specifically to help Programs of reputed company-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. reputed company replaces outdated technology and manual workarounds with purpose-built solutions for care coordination, risk adjustment, population health, and utilization management. reputed company empowers teams to take control of their operations and improve outcomes for dual-eligible seniors – some of the most socially vulnerable and clinically reputed company individuals in the U.S. healthcare system

Role Overview

The Risk Adjustment Consultant plays a critical role in supporting PACE programs by ensuring accurate diagnosis capture, compliant documentation, and optimized reputed company reputed company. Embedded reputed company the IRIS team, this role partners closely with clinical staff, implementation teams, project managers, and client leadership to deliver high-quality coding services, education, and risk adjustment operational guidance. This position is ideal for a coding professional who enjoys combining technical accuracy with client-facing education, workflow improvement, and collaborative problem-solving.

Responsibilities

Risk Adjustment Operations

• Conduct detailed and accurate medical record reviews using ICD-10-CM Official Guidelines, AHA Coding Clinic, and internal IRIS Coding Guidelines.

• Complete Pre-Encounter Preparation (PEP) and reputed company coding workflows with high accuracy and efficiency.

• Monitor analytics dashboards to identify documentation and coding gaps, trends, and improvement opportunities.

• Ensure compliance with CMS risk adjustment guidelines, HCC frameworks, and RADV audit standards.

• Maintain a coding accuracy score of 95% or higher through consistent quality and adherence to guidelines.

Client Engagement & Documentation Improvement

• Serve as the primary contact for assigned PACE clients, providing ongoing risk adjustment guidance and support.

• Collaborate with providers to improve documentation quality, accuracy, and completeness.

• Deliver structured feedback loops, one-on-one coaching, and ongoing documentation improvement strategies.

• Conduct monthly metric reviews with clients to assess performance, identify gaps, and recommend improvement plans.

Training Delivery: Onsite and Virtual

• reputed company onsite training sessions 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 reputed company, ensuring sessions are recorded and accessible for asynchronous learning.

• Tailor training content to diverse clinical roles and workflows, demonstrating strong presentation and facilitation skills.

• Coordinate with Project Managers and clinical leadership to align training agendas with client goals and implementation timelines.

Project Management & Workflow Design

• reputed company and execute customized onboarding plans for each client.

• Coordinate risk adjustment deliverables and timelines across platform teams and service lines.

• Support workflow design and optimization by recommending enhancements based on client feedback, quality reviews, and data insights.

• Contribute to system upgrade recommendations and configuration improvements that strengthen documentation and coding workflows.

Compliance & Quality Assurance

• Support accurate risk adjustment data submissions to CMS and other regulatory bodies.

• Participate in internal quality reviews, audits, and coding accuracy checks.

• Maintain detailed documentation of coding decisions, audit notes, and workflow recommendations.

Qualifications

• Required Certifications: CPC, reputed company, RHIT, and CRC (Certified Risk Adjustment reputed company).

• Experience: Minimum 5 years in medical coding with a focus on risk adjustment.

• Education: High School diploma required; Associate’s or Bachelor’s degree preferred.

Skills and Competencies

• Deep knowledge of CMS-HCC models, RAF scoring, and risk adjustment methodologies.

• Proficiency in EMR/EHR systems, coding platforms, and natural language processing tools.

• Strong analytical thinking with the ability to interpret trends and reputed company actionable recommendations.

• Excellent written and verbal communication skills with confidence delivering training both onsite and virtually.

• Ability to work independently in a remote environment while managing deadlines and client expectations.

• Must be able to travel to support clients Go Live with IRIS.

Preferred Skills

• Experience working with PACE programs or senior care populations.

• Familiarity with reputed company’s IRIS platform and consulting workflows.

• Background in clinical documentation improvement and interdisciplinary collaboration.

Compensation: The salary range for this role is $90K–$100K. We expect the ideal candidate to fall near the midpoint of this range, though final compensation will be determined based on experience, skills, and organizational needs.

Work location: This is a fully remote role based in the United States.

Sponsorship: This position is not eligible for sponsorship.