Risk Adjustment Advisor

Senior Advisor, Risk Adjustment
Insight Global is seeking an experienced health plan risk adjustment professional to guide market exploration, product discovery, and solution design for next-generation risk adjustment capabilities. This role partners closely with Product, Engineering, Sales, Marketing, and Implementation teams to ensure our solutions reflect real-world operational workflows, regulatory requirements, and customer needs. The Senior Advisor, Risk Adjustment serves as the voice of the customer and a trusted subject matter expert for both technical and business stakeholders.
Responsibilities
Serve as trusted advisor and subject matter expert supporting product development efforts on risk adjustment for the health plan market
Translate customer and market needs into product requirements, solution designs, and implementation plans
Evaluate AI-generated outputs and prompt strategies to improve accuracy, explainability, and regulatory compliance
Perform user acceptance testing (UAT) of prototypes to assess user experience and audit defensibility
Ensure solutions align with CMS standards, audit requirements, and data governance best practices such as Encounter Data Record
Partner with Product, Sales, Marketing, and Implementation teams to support product positioning and commercialization efforts
Represent the voice of the customer during solution discussions and technical evaluations.
Required Qualifications
Bachelor’s degree or equivalent experience
7+ years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations, with at least 2 years in a supervisory role
Knowledge of full risk adjustment lifecycle from claims analysis to clinical chart chase to submission and audit
Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologies
Strong knowledge of ICD-10-CM coding guidelines as applied to HCC risk adjustment
Experience performing risk adjustment in compliance with CMS-HCC V28 standards and preparing/responding to RADV audits
Experience leading or supervising health plan risk adjustment operations, including coder oversight, quality review, and/or audit readiness
Experience supporting health IT product discovery, development, sales, and/or implementation
Experience in both Medicare Advantage and ACA plans risk adjustment
Familiarity with RAPS and EDGE submission processes
Preferred Qualifications
CRC, CPC, or CCS credential
Familiarity with AI-assisted coding tools, prompt engineering, and evaluating AI-generated risk adjustment content
Compensation
$120/hr to $130/hr
Exact compensation may vary based on several factors, including skills, experience, and education.
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.

Work arrangement
Yes