Managing Consultant - Risk Adjustment Coding Compliance

TL;DR

Managing Consultant - Risk Adjustment Coding Compliance: Execute coding compliance engagement work streams by auditing provider claims and clinical documentation with an accent on ICD-10-CM codes that risk adjust under the CMS-HCC model for Medicare. Focus on designing audit plans, analyzing and reporting discrepancies, and communicating findings to stakeholders while staying current on CPT-4/HCPCS, ICD-10-CM, AHA coding clinics, and CMS oversight.

Location: Tampa, FL (hybrid preferred; remote candidates considered)

Salary: $100,000 – $230,000

Company

hirify.global (BRG) delivers data-driven consulting across healthcare analytics, economics, disputes, and investigations.

What you will do

• Design coding and documentation audit plans for annual and periodic audits and investigations based on key risk areas.
• Conduct coding and documentation quality audits against CPT-4/HCPCS, ICD-10-CM, and CMS coverage guidelines; review external audit results (e.g., CMS RADV) and support appeals.
• Analyze audit findings to identify trends and recommend improvements; lead educational meetings with providers/health plans/legal counsel as needed.
• Assist with reviewing, editing, or writing billing and coding compliance policies and provider/coder education trainings.
• Serve as a subject matter expert on interpretation and application of coding and documentation guidelines; generate client deliverables and contribute to expert reports.
• Manage junior staff and delegate assignments; prioritize work to meet goals and deadlines while ensuring HIPAA compliance.

Requirements

• Bachelor’s degree in Health Information Management or a related healthcare field.
• Minimum 5 years of risk adjustment coding experience as an auditor/coder in a health plan or medical group/physician office setting.
• Minimum 3 years of medical coding experience (CPT-4/HCPCS and ICD-10-CM) in a medical group/physician office setting.
• Active medical coding certification (CPC or CCS-P) via AAPC or AHIMA, and active risk adjustment coder certification (CRC) via AAPC.
• Comprehensive knowledge of Medicare rules and guidelines for coverage, coding, and provider documentation; advanced knowledge of CPT-4, HCPCS, and ICD-10-CM including ability to research coding questions.
• Must be able to submit verification of legal right to work in the U.S., without company sponsorship.

Culture & Benefits

• Hybrid work is strongly preferred with Tampa, FL office-based collaboration; remote candidates are also considered.
• Work focuses on independent, data-driven approaches to complex legal and regulatory healthcare challenges.
• Emphasis on staying current with coding guidelines, CMS-HCC model changes, and compliance/enforcement activity.
• Requires strong attention to detail, communication, and time management to deliver high-quality client work products.

Hiring process

• Compensation and title level are determined based on qualifications and experience.
• Interviews and evaluation focus on coding compliance expertise, audit experience, and communication of findings.