Senior Solutions Consultant – Risk Adjustment

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $142k - $177k / year

⏰ Full Time

🟠 Senior

💻 Solutions Engineer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• 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

• 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

• 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