Clinical Risk Management Analyst

E-Verify Program

. Deliver provider‑ and practice‑level education on risk adjustment documentation and ICD‑10‑CM coding best practices using performance data, audit findings, and CMS guidance .

Posted 4/23/2026full-timeRemote • North Carolina, South Carolina, Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $73,698 - $117,917 per yearWebsite

About the role

Key responsibilities & impact

Deliver provider‑ and practice‑level education on risk adjustment documentation and ICD‑10‑CM coding best practices using performance data, audit findings, and CMS guidance
Translate complex risk adjustment analytics into clear, actionable insights for clinical and non‑clinical audiences
Provide timely, objective feedback to providers and practice leadership, including recommended action plans when performance gaps or risks are identified
Develop and maintain benchmarking, trending, and month‑over‑month performance reporting at the provider, practice, and departmental level
Collaborate closely with internal partners including Risk Analytics, Quality, Cost of Care Consultants, Member Engagement, Coding Audit, and Chart Outreach
Serve as a subject matter expert in risk adjustment coding and documentation, ensuring CMS‑compliant and audit‑defensible practices

Requirements

What you’ll need

Registered Nurse (RN) with 3+ years of clinical experience OR Licensed Practical Nurse (LPN) with 5+ years of clinical experience
Must have previous work experience in applicable business area (i.e. risk adjustment, provider education, consultation, engagement roles)
Bachelor's degree or advanced degree preferred
Certifications: CPC or CRC certification required, with demonstrated experience applying ICD‑10‑CM and HCC coding in a risk adjustment environment
CCS (Certified Coding Specialist – AHIMA) will be considered with applicable outpatient ICD‑10‑CM and HCC coding experience

Benefits

Comp & perks

Annual Incentive Bonus*
401(k) with employer match
Paid Time Off (PTO)
Competitive health benefits and wellness programs

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

ICD-10-CM codingrisk adjustment documentationbenchmarkingperformance reportingHCC codingcoding auditanalyticsactionable insightsperformance dataaudit findings

Soft Skills

communicationcollaborationfeedbackeducationconsultationleadershipobjectivityproblem-solvingtranslating complex informationengagement

Certifications

CPCCRCCCS