The Risk Adjustment Performance Consultant provides advisory and performance improvement services to healthcare organizations, helping customers strengthen their risk adjustment practices and accurately reflect the clinical complexity of their patient populations. The role works directly with clinical and operational leaders, providers, coding teams, and value-based care stakeholders to establish priorities, develop tailored strategies, and guide sustainable improvements in documentation, workflows, and technology adoption.
Responsibilities include assessing current risk adjustment practices, understanding payer and contract priorities, and recommending improvements to patient outreach, pre-visit planning, Annual Wellness Visits, and review of prior-year and suspected conditions. The consultant delivers organizational education and targeted provider coaching on HCC concepts, appropriate coding, and clinically supported documentation. Chart-review findings and provider-specific examples inform practical guidance that helps care teams improve documentation quality within their daily workflows.
The consultant guides effective use of Oracle Health solutions, including Diagnosis Insights and related risk adjustment tools, and helps customers incorporate available features into their operations. Performance analysis supports the identification of priority populations, providers, and education needs. The role establishes performance baselines, develops scorecards and recommendations, conducts regular customer progress reviews, and adjusts strategies based on results throughout the performance year.
The position requires 6-8 years experience in risk adjustment, HCC documentation and coding, provider education, or value-based care consulting. Strong facilitation, communication, analytical, and relationship-management skills are essential, along with the ability to assess operational challenges and guide customer teams through improvement efforts. Knowledge of payer contracts and risk models across Medicare, Medicare Advantage, Medicaid, and commercial populations is valuable. Familiarity with Oracle Health workflows and population health solutions is preferred.
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