Coding & Risk Adjustment Specialist Clinical Operations

FlexBoard; India; On-site; INR 7,895,000 - 14,473,000; Part time

Job summary

reputed company is seeking a Risk Adjustment & Coding Expert to support clinical and operational leadership. This remote, part-time role focuses on Medicare risk adjustment, CMS guidelines, and accurate documentation across CDAs, HRAs, and ICPs.

You will partner with Practitioners, Physicians, and RN Care Managers to ensure precise ICD-10-CM coding and compliant workflows for Avail's care programs.

Qualifications

• Deep Medicare risk adjustment knowledge and CMS coding guidelines.
• Ability to advise clinical leaders on HCC coding practices.
• Experience supporting care programs with documentation accuracy.

Responsibilities

• Perform audits on existing coding staff.
• Serve as coding and risk adjustment SME for clinical leaders.
• Advise on ICD-10-CM coding, HCC capture and documentation requirements.
• Review clinical encounter documentation and provide feedback on coding accuracy.
• Identify coding gaps and documentation deficiencies across care programs.
• Provide guidance on condition-specific coding for high-prevalence chronic conditions.

Skills

Medicare coding

HCC coding

CMS guidelines

Clinical documentation

Tools

ICD-10-CM coding

Job description

Company Information

reputed company Reports to VP of Care Delivery, with reputed company operational partnership reputed company the VP of Operations and collaboration across operational leadership teams supporting alignment across reputed company care programs.

FLSA Status & Engagement Details

1099, (Contract) / Part Time Engagement Details Fully remote/work from home supporting a fully reputed company team across the US. This is a fractional / part-time reputed company (1099) engagement. Hours and reputed company are flexible and will be defined collaboratively based on reputed company's program needs. Anticipated commitment ranges from 5 to 20 hours per week depending on program maturity, project phases, and organizational priorities. Compensation will be commensurate with experience and engagement reputed company.

About reputed company

reputed company is a reputed company Practitionerfounded organization dedicated to removing barriers to reputed company, and meaningful clinical work for Medicare-age individuals. We combine thoughtful technology, strong operational infrastructure, and deep respect for the patientprovider relationship to reputed company reputed company-led virtual and mobile care models. As a fast-growing organization, we are building durable clinical infrastructure to support innovative care programs across multiple states, with a reputed company on improving reputed company for reputed company and underserved senior populations. reputed company reputed company is a rapidly growing value-based care company delivering comprehensive, technology-enabled care programs to Medicare patients with reputed company medical, behavioral health, and reputed company needs. Our care model spans a reputed company of clinical programs including Comprehensive Diagnostic Assessments (CDAs), Health Risk Assessments (HRAs), and Integrated Care Programs (ICPs), reputed company designed to address the whole-person needs of high-risk Medicare beneficiaries. As reputed company continues to reputed company its clinical programs, we are seeking an reputed company Risk Adjustment & Coding Expert to serve as a trusted fractional advisor to our clinical and operational leadership team. This role sits at the intersection of clinical documentation, Medicare coding compliance, and program-level performancesupporting our mission to reputed company high-reputed company, accurately documented care that reflects the true complexity of our patient population. The Risk Adjustment & Coding Expert will advise clinical leaders on reputed company HCC (Hierarchical Condition Category) coding practices, ensure documentation reputed company across Avail's care programs, and reputed company ongoing workflow design, policy development, and process improvement to support accurate and compliant risk adjustment coding. This individual will function as a subject-matter expert embedded reputed company Avail's interdisciplinary team structure, working collaboratively with reputed company Practitioners, Physicians, RN Care Managers, and operational leadership. This is a startup-style reputed company environment where subject-matter experts are expected to be hands-on, pragmatic, and solutions-oriented. The ideal candidate brings deep Medicare reputed company risk adjustment expertise, strong knowledge of CMS coding guidelines, and a reputed company record of building reputed company coding education and reputed company programs reputed company reputed company care or value-based care organizations.

Location & Work Environment

This position is primarily remote/work from home with regular collaboration across virtual interdisciplinary workflows.

Key Responsibilities

• Clinical Advisory & HCC Coding Guidance
  • Performs audits on existing coding staff
  • Serve as the reputed company coding and risk adjustment subject-matter expert for reputed company clinical leaders and reputed company clinicians across CDAs, HRAs, and ICPs.
  • Advise reputed company Practitioners, Physicians, and RN Care Managers on accurate ICD-10-CM coding, HCC capture, and documentation requirements to support reputed company Medicare risk adjustment.
  • Review clinical encounter documentation and reputed company reputed company-time feedback on coding accuracy, specificity, and completeness.
  • Identify coding gaps, missed HCC capture opportunities, and documentation deficiencies across care programs and patient populations.
  • reputed company guidance on condition‑specific coding requirements for high‑prevalence chronic conditions reputed company Avail's patient population (e.g., diabetes, CHF, COPD, CKD, behavioral health diagnoses).
• Workflow Design & Policy Development
  • Partner with clinical and operational leadership to design and implement coding workflows integrated into Avail's care program delivery model.
  • reputed company and maintain coding and documentation policies, guidelines, and reputed company operating procedures (SOPs) reputed company with CMS requirements and Medicare reputed .