Coding & Risk Adjustment Specialist – Clinical Operations

Avail Health•,

2d•Remote

About The Position

Avail Health is seeking an experienced Coding & Risk Adjustment Specialist to support its growing clinical programs in a flexible, part-time consulting capacity. The specialist will serve as a subject-matter expert in Medicare Advantage risk adjustment, HCC coding, and clinical documentation integrity, collaborating with clinical and operational leadership to strengthen coding accuracy, optimize documentation practices, conduct audits, and develop scalable workflows that support compliance and program performance. The role is fully remote and is expected to require approximately 5–20 hours per week, with hours and scope established collaboratively based on organizational needs, program priorities, and project requirements. Compensation is commensurate with experience and the agreed-upon scope of services.

Requirements

Certified Risk Adjustment Coder (CRC) certification.
At least 5 years of experience in Medicare risk adjustment coding, HCC coding, or clinical documentation improvement (CDI).
Strong knowledge of ICD-10-CM coding guidelines, CMS-HCC models, and Medicare Advantage risk adjustment methodology.
Experience reviewing clinical documentation and advising healthcare providers on coding accuracy and documentation best practices.
Demonstrated ability to develop or deliver coding education, training, and quality improvement initiatives.
Proficiency with electronic medical record (EMR) systems, coding tools, and documentation review processes.
Strong analytical, organizational, and communication skills.
Ability to work independently in a flexible, remote consulting environment.

Nice To Haves

Certified Professional Coder (CPC) certification.
Experience with risk adjustment coding and documentation in PACE programs, including CMS-HCC V22–V28 models.
Background in value-based care, Medicare Advantage, population health, or complex care management.
Familiarity with Comprehensive Diagnostic Assessments (CDAs), Health Risk Assessments (HRAs), Annual Wellness Visits (AWVs), and Transitional Care Management (TCM).
Experience supporting RADV audits, coding compliance programs, and risk adjustment quality initiatives.
Experience presenting coding performance findings and recommendations to clinical leadership or external clients.
Experience working in a fast-paced, growing healthcare organization.

Responsibilities

Provide expertise and guidance on ICD-10-CM coding, HCC capture, and Medicare Advantage documentation requirements.
Conduct coding audits and clinical documentation reviews to evaluate accuracy, completeness, compliance, and improvement opportunities.
Audit existing coding staff and provide actionable feedback to improve coding quality and consistency.
Partner with Nurse Practitioners, Physicians, RN Care Managers, and operational leaders to improve coding practices across clinical programs.
Develop and implement coding workflows, policies, standard operating procedures, and documentation guidelines aligned with CMS requirements.
Design and deliver coding education and provider training, and create practical reference materials for clinical teams.
Identify missed HCC capture opportunities, documentation gaps, and coding trends to support accurate risk adjustment.
Monitor coding quality metrics, risk adjustment performance, and regulatory updates, and provide recommendations to leadership.
Support risk adjustment data validation, encounter submission workflows, revenue integrity initiatives, and preparation for RADV and other compliance audits.
Collaborate with internal teams and external clients to communicate coding performance, documentation findings, and process improvement opportunities.