Coding & Risk Adjustment Specialist - Clinical Operations

Coding & Risk Adjustment Specialist – Clinical Operations

Company: Avail Health
Location: Remote (U.S.)
Employment Type: Part-Time, Independent Contractor (1099)
Hours: Approximately 15 hours per week
Compensation: Commensurate with experience and scope of engagement

About Avail Health

Avail Health is a Nurse Practitioner-founded, rapidly growing healthcare organization dedicated to improving access to high-quality care for Medicare-age individuals. Through innovative, technology-enabled virtual and mobile care models, we support patients with complex medical, behavioral health, and social needs.

Our team is passionate about improving patient outcomes, empowering clinicians, and building scalable care delivery solutions for underserved senior populations.

About the Role

Avail Health is seeking an experienced Coding & Risk Adjustment Specialist to support our growing clinical programs in a flexible, part-time consulting capacity.

In this role, you will serve as a subject-matter expert in Medicare Advantage risk adjustment, HCC coding, and clinical documentation integrity. You will collaborate closely with clinical and operational leadership to strengthen coding accuracy, optimize documentation practices, conduct audits, and develop scalable workflows that support compliance and program performance.

The ideal candidate brings extensive Medicare risk adjustment expertise, a strong understanding of CMS coding requirements, and experience translating complex coding guidelines into practical solutions for clinical teams.

This is an excellent opportunity for an experienced coding professional who enjoys working independently, advising healthcare leaders, and contributing to

Key Responsibilities

• Serve as a coding and risk adjustment subject-matter expert, providing guidance on ICD-10-CM coding, HCC capture, and Medicare Advantage documentation requirements.

• Conduct coding audits and clinical documentation reviews to evaluate accuracy, completeness, compliance, and opportunities for improvement.

• Audit existing coding staff and provide actionable feedback to strengthen coding quality and consistency.

• Partner with Nurse Practitioners, Physicians, RN Care Managers, and operational leaders to improve coding practices across clinical programs.

• Develop and implement coding workflows, policies, standard operating procedures (SOPs), and documentation guidelines aligned with CMS requirements.

• Design and deliver coding education, provider training, and practical reference materials for clinical teams.

• Identify missed HCC capture opportunities, documentation gaps, and coding trends to support accurate risk adjustment.

• Monitor coding quality metrics, risk adjustment performance, and regulatory updates, providing recommendations to leadership.

• Support risk adjustment data validation, encounter submission workflows, revenue integrity initiatives, and preparation for RADV and other compliance audits.

• Collaborate with internal teams and external clients to communicate coding performance, documentation findings, and opportunities for process improvement.

Required Qualifications

• Certified Risk Adjustment Coder (CRC) certification required.

• Minimum of 5 years of experience in Medicare risk adjustment coding, HCC coding, or clinical documentation improvement (CDI).

• Strong knowledge of ICD-10-CM coding guidelines, CMS-HCC models, and Medicare Advantage risk adjustment methodology.

• Experience reviewing clinical documentation and advising healthcare providers on coding accuracy and documentation best practices.

• Demonstrated ability to develop or deliver coding education, training, and quality improvement initiatives.

• Proficiency with electronic medical record (EMR) systems, coding tools, and documentation review processes.

• Strong analytical, organizational, and communication skills.

• Ability to work independently in a flexible, remote consulting environment.

Preferred Qualifications

• Certified Professional Coder (CPC) certification.

• Experience with risk adjustment coding and documentation in PACE (Program of All-Inclusive Care for the Elderly) programs, including CMS-HCC V22–V28 models.

• Background in value-based care, Medicare Advantage, population health, or complex care management.

• Familiarity with Comprehensive Diagnostic Assessments (CDAs), Health Risk Assessments (HRAs), Annual Wellness Visits (AWVs), and Transitional Care Management (TCM).

• Experience supporting RADV audits, coding compliance programs, and risk adjustment quality initiatives.

• Experience presenting coding performance findings and recommendations to clinical leadership or external clients.

• Experience working in a fast-paced, growing healthcare organization.

Engagement Details

This is a fully remote, part-time independent contractor (1099) opportunity with an anticipated commitment of approximately 15hours per week . Hours and scope will be established collaboratively based on organizational needs, program priorities, and project requirements.

Compensation will be commensurate with experience and the agreed-upon scope of services.

Join Our Team

At Avail Health, you'll have the opportunity to apply your expertise in a meaningful way, collaborating with clinical and operational leaders to strengthen care delivery, improve documentation integrity, and support innovative healthcare programs.

If you're an experienced risk adjustment coding professional who enjoys solving complex challenges, building efficient processes, and making an impact in value-based care, we'd love to hear from you.