Risk Adjustment Consultant

IntusCare

104d • $70,000 - $90,000

About The Position

IntusCare is a healthcare analytics platform that synthesizes healthcare data to identify risks, visualize trends, and optimize care for PACE programs. IntusCare empowers care providers to mitigate high risk events and equips executives with the tools to make informed decisions based on comprehensive clinical and operational data. Our mission is to catalyze data-driven change to achieve high-value, multi-disciplinary care for older adults. In addition, IntusCare offers a broad range of technical assistance and consulting services to support PACE programs under development and existing programs that are growing and evolving to meet the needs of their communities. The Risk Adjustment Consultant at IntusCare plays a pivotal role in supporting PACE programs, by ensuring accurate, compliant, and complete risk adjustment documentation and coding. This role is embedded within the IRIS (Intus Revenue Integrity Services) team and works closely with implementation specialists, clinical teams, and client leadership to optimize risk score accuracy and revenue integrity.

Requirements

• Required Certifications: CPC, CCS, RHIT, and CRC (Certified Risk Adjustment Coder).
• 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.
• Strong understanding of CMS risk adjustment models and HCC coding.
• Proficiency in EMR systems and natural language processing tools.
• Excellent communication and analytical skills.
• Ability to work independently and remotely.
• Confident in presenting trainings both in-person and virtually.

Nice To Haves

• Experience working with PACE programs or senior care populations.
• Familiarity with IntusCare’s IRIS platform and consulting workflows.
• Background in clinical documentation improvement and interdisciplinary collaboration.

Responsibilities

• Conduct detailed reviews of medical records to validate diagnosis coding using ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic, and internal IRIS Coding Guidelines.
• Complete Pre-Encounter Preparation (PEP) and concurrent coding workflows.
• Monitor analytics dashboards to identify coding gaps and provide data-driven education.
• Ensure compliance with CMS guidelines and RADV audit standards.
• Serve as the primary point of contact for assigned PACE clients.
• Collaborate with providers to improve documentation practices and coding accuracy.
• Deliver training sessions and feedback loops to clinical teams on documentation improvement.
• Conduct Monthly metric reviews and educational sessions with clients.
• Lead live onsite training sessions during go-live phases and onboarding events, including Risk Adjustment 101, PEP review, and personalized provider coaching.
• Host virtual training sessions for provider workflow education, analytics platform usage, and ongoing documentation refreshers.
• Conduct biweekly virtual office hours and record sessions for asynchronous access.
• Adapt training delivery to client needs, coordinating with project managers and clinical leadership to align agendas and strategic goals.
• Demonstrate strong presentation skills and solution-oriented thinking to tailor sessions to diverse provider workflows.
• Develop and execute customized onboarding plans for each client.
• Coordinate implementation timelines and deliverables across service platforms.
• Suggest system upgrades and workflow enhancements based on client feedback.
• Support submission of accurate data to CMS and other regulatory bodies.
• Participate in internal audits and quality assurance reviews.
• Maintain a coding accuracy score of 95% or higher.

Benefits

• Salary range: $70K–$90K, with final compensation based on experience, skills, and organizational needs.
• Fully remote role based in the United States.

What This Job Offers

• Education Level: High school or GED