IntusCare - Risk Adjustment Consultant
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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. • 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 develop 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. • 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. • Work location: This is a fully remote role based in the United States. • Sponsorship: This position is not eligible for sponsorship.
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 concurrent 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 • Lead 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 office hours, 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 • 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 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.
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