Senior Solutions Consultant - Risk Adjustment

Overview

The Senior Solutions Consultant for Risk Adjustment serves as Cotiviti's subject matter expert and trusted advisor for payer and provider risk adjustment, with a primary focus on prospective and concurrent strategies. This role partners with Sales and cross-functional teams to understand client needs, assess solution fit, deliver compelling demonstrations and presentations, support RFP responses, and shape solutions that improve compliant risk identification, documentation, provider workflows, and financial performance. The Senior Solutions Consultant translates client and market needs into solution recommendations and brings field insights back to Product teams.

Responsibilities

Pre-Sales Support & Customer Engagement

• Partner with Sales on opportunities involving risk adjustment analytics, prospective and concurrent workflows, and provider engagement.
• Demonstrate Cotiviti's risk adjustment analytics, workflow, 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 adjustment strategies, current workflows, data and integration requirements, operational challenges, and success measures.
• Support pilot and proof-of-concept initiatives that demonstrate solution value, operational fit, and measurable outcomes.

Solution Design & RFP Support

• Develop technical content for risk adjustment RFP and proposal responses.
• Design solution recommendations that address customer-specific prospective and concurrent risk adjustment needs, provider workflows, and operational challenges.
• Articulate ROI and business value tied to compliant risk identification, documentation accuracy, provider workflow efficiency, and timely intervention.
• Present during finalist presentations with a clear focus on client outcomes, workflow fit, and measurable value.

Market Intelligence & Product Feedback

• Monitor regulatory, market, and operational trends affecting Medicare Advantage risk adjustment, prospective and concurrent strategies, and provider workflows.
• Capture competitive intelligence on risk adjustment analytics, workflow solutions, and related market offerings.
• Communicate customer needs, solution gaps, and enhancement priorities to Product Management.
• Contribute to risk adjustment case studies, sales enablement materials, commercialization content, and thought leadership.

Subject Matter Expertise

• Maintain deep expertise in health plan risk adjustment strategies and operations, with emphasis on prospective and concurrent approaches.
• Maintain expertise in CMS-HCC models, compliant documentation and coding, provider engagement, and risk adjustment program operations.
• Understand end-to-end risk adjustment workflows, including risk identification and prioritization, provider engagement, point-of-care review, post-encounter validation, concurrent review, coding, and encounter submission.
• Stay current on risk adjustment model changes, documentation and coding guidance, regulatory requirements, and industry best practices.
• Develop training materials and deliver internal enablement on risk adjustment concepts, client needs, and solution positioning.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Health Information Management, or a related field, or equivalent relevant experience.
• 10+ years of relevant experience in risk adjustment, health plan operations, healthcare technology, consulting, or a related field.
• Deep knowledge of Medicare Advantage risk adjustment programs, with practical understanding of prospective and concurrent risk adjustment operations.
• Strong understanding of CMS-HCC models, ICD-10-CM documentation and coding concepts, provider workflows, and risk adjustment analytics.
• Experience in pre-sales, solution consulting, consulting, customer-facing product, or health plan advisory roles.
• Strong presentation and demonstration skills with executive, operational, and technical audiences.
• Excellent written and verbal communication skills with the ability to translate complex clinical, technical, and operational concepts into clear business value.

Preferred qualifications

• Experience working directly for a health plan in risk adjustment, analytics, provider engagement, clinical operations, or revenue optimization.
• Professional coding or risk adjustment credential such as CRC, CPC, CCS, RHIT, CDIP, or similar certification.
• Familiarity with ACA and/or Medicaid risk adjustment programs in addition to Medicare Advantage.
• Experience with provider-facing workflows, EHR-enabled processes, healthcare analytics, or data integration.
• Experience supporting pilots, sales enablement, solution launches, or commercialization of healthcare technology solutions.

Cognitive / Mental Requirements

• Ability to analyze complex information and communicate it clearly to diverse audiences.
• Strong critical thinking, problem solving, and decision-making skills.
• Capacity to manage multiple proprieties and maintain attention to detail.
• Effective memory and recall to stay current on solution knowledge and industry practices.
• Mental flexibility to adapt communication style and approach to different situations.
• Ability to remain composed and think quickly under pressure.
• Strong organizational and planning skills to support client engagements and sales activities.

Physical Requirements and Working Conditions

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Base compensation ranges from $142,000 to $177,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.Since this job will be based remotely, all interviews will be conducted virtually.

Date of posting: 10/20/2026

Applications are assessed on a rolling basis. We anticipate that the application window will close on 11/20/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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