Senior Solutions Consultant - Risk Adjustment

Cotiviti • Remote,

4d • $142,000 - $177,000 • Remote

About The Position

The Senior Solutions Consultant for Risk Adjustment serves as Cotiviti's subject matter expert and trusted advisor for payer and provider risk adjustment, with a primary focus on prospective and concurrent strategies. The role partners with Sales and cross-functional teams to understand client needs, assess solution fit, deliver demonstrations and presentations, support RFP responses, and shape solutions that improve compliant risk identification, documentation, provider workflows, and financial performance. The consultant translates client and market needs into solution recommendations and shares field insights with Product teams.

The position supports pre-sales and customer engagement, solution design and RFP responses, market intelligence and product feedback, and internal subject-matter enablement. It requires deep expertise in health plan risk adjustment strategies and operations, especially prospective and concurrent approaches, as well as CMS-HCC models, compliant documentation and coding, provider engagement, and end-to-end risk adjustment workflows.

This is a remote-based role. The employee must have high-speed internet access and connectivity, an office setup, and a dedicated secure work area. Cotiviti states that the job description describes the general nature and level of work and may change as business needs change.

Requirements

• Bachelor's degree in Healthcare Administration, Business, Health Information Management, or a related field, or equivalent relevant experience.
• 10+ years of relevant experience in risk adjustment, health plan operations, healthcare technology, consulting, or a related field.
• Deep knowledge of Medicare Advantage risk adjustment programs and practical understanding of prospective and concurrent risk adjustment operations.
• Strong understanding of CMS-HCC models, ICD-10-CM documentation and coding concepts, provider workflows, and risk adjustment analytics.
• Experience in pre-sales, solution consulting, consulting, customer-facing product, or health plan advisory roles.
• Strong presentation and demonstration skills with executive, operational, and technical audiences.
• Excellent written and verbal communication skills, including the ability to translate complex clinical, technical, and operational concepts into clear business value.
• Ability to analyze complex information and communicate it clearly to diverse audiences.
• Strong critical thinking, problem-solving, and decision-making skills.
• Ability to manage multiple priorities and maintain attention to detail.
• Effective memory and recall to stay current on solution knowledge and industry practices.
• Mental flexibility to adapt communication style and approach to different situations.
• Ability to remain composed and think quickly under pressure.
• Strong organizational and planning skills to support client engagements and sales activities.
• Ability to remain in a stationary position, often standing or sitting for prolonged periods.
• Ability to perform repetitive motions that may include the wrists, hands, and/or fingers.
• Must be able to provide high-speed internet access and connectivity, an office setup and maintenance, and a dedicated, secure work area.

Nice To Haves

• Experience working directly for a health plan in risk adjustment, analytics, provider engagement, clinical operations, or revenue optimization.
• Professional coding or risk adjustment credential such as CRC, CPC, CCS, RHIT, CDIP, or similar certification.
• Familiarity with ACA and/or Medicaid risk adjustment programs in addition to Medicare Advantage.
• Experience with provider-facing workflows, EHR-enabled processes, healthcare analytics, or data integration.
• Experience supporting pilots, sales enablement, solution launches, or commercialization of healthcare technology solutions.

Responsibilities

• Partner with Sales on opportunities involving risk adjustment analytics, prospective and concurrent workflows, and provider engagement.
• Demonstrate Cotiviti's risk adjustment analytics, workflow, and decision-support capabilities.
• Present to health plan risk adjustment, coding, clinical, provider engagement, technology, and executive teams.
• Conduct discovery sessions to understand customer strategies, workflows, data and integration requirements, operational challenges, and success measures.
• Support pilot and proof-of-concept initiatives that demonstrate solution value, operational fit, and measurable outcomes.
• Develop technical content for risk adjustment RFP and proposal responses.
• Design solution recommendations for customer-specific prospective and concurrent risk adjustment needs, provider workflows, and operational challenges.
• Articulate ROI and business value tied to compliant risk identification, documentation accuracy, provider workflow efficiency, and timely intervention.
• Present during finalist presentations, focusing on client outcomes, workflow fit, and measurable value.
• Monitor regulatory, market, and operational trends affecting Medicare Advantage risk adjustment, prospective and concurrent strategies, and provider workflows.
• Capture competitive intelligence on risk adjustment analytics, workflow solutions, and related market offerings.
• Communicate customer needs, solution gaps, and enhancement priorities to Product Management.
• Contribute to risk adjustment case studies, sales enablement materials, commercialization content, and thought leadership.
• Maintain expertise in health plan risk adjustment strategies and operations, CMS-HCC models, compliant documentation and coding, provider engagement, and program operations.
• Understand end-to-end risk adjustment workflows, including risk identification and prioritization, provider engagement, point-of-care review, post-encounter validation, concurrent review, coding, and encounter submission.
• Stay current on risk adjustment model changes, documentation and coding guidance, regulatory requirements, and industry best practices.
• Develop training materials and deliver internal enablement on risk adjustment concepts, client needs, and solution positioning.

Benefits

• Medical insurance coverage
• Dental insurance coverage
• Vision insurance coverage
• Disability insurance coverage
• Life insurance coverage
• 401(k) savings plans
• Paid family leave
• 9 paid holidays per year
• 17–27 days of paid time off per year, depending on level and length of service

What This Job Offers

• Job Type: Full-time
• Career Level: Senior