Risk Adjustment Consultant

About IntusCare

IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen financial performance, and stay compliant. IntusCare replaces outdated technology and manual workarounds with purpose-built solutions for care coordination, risk adjustment, population health, and utilization management. IntusCare empowers teams to take control of their operations and improve outcomes for dual-eligible seniors – some of the most socially vulnerable and clinically complex individuals in the U.S. healthcare system

Role Overview

The Risk Adjustment Consultant plays a critical role in supporting PACE programs by ensuring accurate diagnosis capture, compliant documentation, and optimized revenue integrity. Embedded within the IRIS team, this role partners closely with clinical staff, implementation teams, project managers, and client leadership to deliver high-quality coding services, education, and risk adjustment operational guidance. This position is ideal for a coding professional who enjoys combining technical accuracy with client-facing education, workflow improvement, and collaborative problem-solving.

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 submi