Senior Risk Adjustment Solutions Consultant (Remote)

Cotiviti; United States; Remote; USD 142,000 - 177,000; Full time

Job summary

Cotiviti is seeking a Senior Solutions Consultant to lead risk adjustment strategy and demonstrations for payer and provider clients. You will partner withSales and cross-functional teams to understand client needs, design prospective and concurrent solutions, and influence product direction with field insights.

The role emphasizes ROI-driven guidance, solution positioning, and ability to translate complex clinical and operational concepts into business value for senior stakeholders.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, HIM or related field.
• 10+ years of risk adjustment, health plan operations, healthcare tech, or related experience.
• Deep knowledge of Medicare Advantage risk adjustment programs and prospective/concurrent operations.
• Strong understanding of CMS-HCC models, ICD-10-CM documentation and coding concepts, provider workflows, and risk analytics.
• Experience in pre-sales, solution consulting, or health plan advisory roles.
• Strong presentation and communication skills for executive, operational, and technical audiences.

Responsibilities

• Partner with Sales on risk adjustment analytics opportunities and workflows.
• Demonstrate risk adjustment analytics, workflows, and decision-support capabilities.
• Present to health plan risk adjustment, coding, clinical, provider engagement, technology, and executive teams.
• Conduct discovery sessions to understand customer risk strategies, data needs, and success measures.
• Support pilots and proof-of-concept initiatives to show value and fit.

Skills

Risk adjustment analytics

Pre-sales

Solution demonstrations

Stakeholder presentations

Healthcare industry knowledge

CMS-HCC models

ICD-10-CM coding concepts

Education

Bachelor's degree in Healthcare Administration, Business, Health Information Management, or related field

Tools

CMS-HCC modeling tools

Job description

Cotiviti is seeking a Senior Solutions Consultant to lead risk adjustment strategy and demonstrations for payer and provider clients. You will partner withSales and cross-functional teams to understand client needs, design prospective and concurrent solutions, and influence product direction with field insights.

The role emphasizes ROI-driven guidance, solution positioning, and ability to translate complex clinical and operational concepts into business value for senior stakeholders.