Senior Solutions Consultant – Risk Adjustment

Cotiviti

. Serve as Cotiviti's subject matter expert and trusted advisor for payer and provider risk adjustment, focusing on prospective and concurrent strategies .

Posted 10/20/2026full-timeRemote • United StatesSenior💰 $142,000 - $177,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Advantage risk adjustment strategies, including CMS-HCC models and ICD-10-CM coding. Capable of delivering tailored solutions and effectively communicating complex concepts to diverse stakeholders.

Highest-signal resume keywords

Medicare Advantage Risk AdjustmentCMS-HCC ModelsICD-10-CM DocumentationRisk Adjustment AnalyticsPresentation Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Risk Adjustment OperationsHealthcare TechnologySolution ConsultingData IntegrationProvider WorkflowsOperational ChallengesROI ArticulationPilot InitiativesProposal DevelopmentWorkflow Solutions

Soft Skills

Critical ThinkingProblem SolvingCommunication SkillsOrganizational SkillsAttention to Detail

Certifications & Qualifications

CRCCPCCCSRHITCDIP

Industry Keywords

Healthcare AdministrationHealth Plan OperationsConsultingSales EnablementClinical Operations

About the role

Key responsibilities & impact

Serve as Cotiviti's subject matter expert and trusted advisor for payer and provider risk adjustment, focusing on prospective and concurrent strategies
Partner with Sales and cross-functional teams to understand client needs and assess solution fit
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 covering customer strategies, workflows, data and integration requirements, operational challenges, and success measures
Support pilot and proof-of-concept initiatives
Develop technical content for risk adjustment RFP and proposal responses
Design customer-specific solution recommendations addressing 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
Monitor regulatory, market, and operational trends affecting Medicare Advantage risk adjustment
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 case studies, sales enablement materials, commercialization content, and thought leadership
Maintain expertise in health plan risk adjustment strategies, CMS-HCC models, compliant documentation and coding, provider engagement, and program operations
Understand end-to-end risk adjustment workflows, including risk identification, provider engagement, point-of-care review, post-encounter validation, concurrent review, coding, and encounter submission
Stay current on model changes, coding guidance, regulatory requirements, and industry best practices
Develop training materials and deliver internal enablement on risk adjustment concepts, client needs, and solution positioning

Requirements

What you’ll need

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
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, with 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
Must be able to provide high-speed internet access/connectivity and office setup and maintenance
Must be able to provide a dedicated, secure work area
Preferred: experience working directly for a health plan in risk adjustment, analytics, provider engagement, clinical operations, or revenue optimization
Preferred: professional coding or risk adjustment credential such as CRC, CPC, CCS, RHIT, CDIP, or similar certification
Preferred: familiarity with ACA and/or Medicaid risk adjustment programs
Preferred: experience with provider-facing workflows, EHR-enabled processes, healthcare analytics, or data integration
Preferred: experience supporting pilots, sales enablement, solution launches, or commercialization of healthcare technology solutions

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance coverage
401(k) savings plans
Paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service
Remote work
Virtual interviews
Equal employment opportunity