Coding & Risk Adjustment Specialist Clinical Operations

Company Information Avail Health Reports to: VP of Care Delivery, with close operational partnership alongside the VP of Operations and collaboration across operational leadership teams supporting alignment across Avail Health care programs. FLSA Status: 1099, (Contract) / Part Time Engagement Details: Fully remote/work from home supporting a fully distributed team across the US. This is a fractional / part-time independent contractor (1099) engagement. Hours and scope are flexible and will be defined collaboratively based on Avail Health's program needs. Anticipated commitment ranges from 5 to 20 hours per week depending on program maturity, project phases, and organizational priorities. Compensation will be commensurate with experience and engagement scope. About Avail Health Avail Health is a Nurse Practitionerfounded organization dedicated to removing barriers to care, access, and meaningful clinical work for Medicare-age individuals. We combine thoughtful technology, strong operational infrastructure, and deep respect for the patientprovider relationship to enable nurse-led virtual and mobile care models. As a fast-growing organization, we are building durable clinical infrastructure to support innovative care programs across multiple states, with a focus on improving outcomes for complex and underserved senior populations. Role Summary Avail Health is a rapidly growing value-based care company delivering comprehensive, technology-enabled care programs to Medicare patients with complex medical, behavioral health, and social needs. Our care model spans a range of clinical programs including Comprehensive Diagnostic Assessments (CDAs), Health Risk Assessments (HRAs), and Integrated Care Programs (ICPs), all designed to address the whole-person needs of high-risk Medicare beneficiaries. As Avail Health continues to scale its clinical programs, we are seeking an experienced Risk Adjustment & Coding Expert to serve as a trusted fractional advisor to our clinical and operational leadership team. This role sits at the intersection of clinical documentation, Medicare coding compliance, and program-level performancesupporting our mission to deliver high-quality, accurately documented care that reflects the true complexity of our patient population. The Risk Adjustment & Coding Expert will advise clinical leaders on proper HCC (Hierarchical Condition Category) coding practices, ensure documentation integrity across Avail's care programs, and drive ongoing workflow design, policy development, and process improvement to support accurate and compliant risk adjustment coding. This individual will function as a subject-matter expert embedded within Avail's interdisciplinary team structure, working collaboratively with Nurse Practitioners, Physicians, RN Care Managers, and operational leadership. This is a startup-style healthcare environment where subject-matter experts are expected to be hands-on, pragmatic, and solutions-oriented. The ideal candidate brings deep Medicare Advantage risk adjustment expertise, strong knowledge of CMS coding guidelines, and a track record of building scalable coding education and quality programs within complex care or value-based care organizations. Location & Work Environment This position is primarily remote/work from home with regular collaboration across virtual interdisciplinary workflows. Key Responsibilities Clinical Advisory & HCC Coding Guidance Performs audits on existing coding staff Serve as the primary coding and risk adjustment subject-matter expert for Avail Health clinical leaders and frontline clinicians across CDAs, HRAs, and ICPs. Advise Nurse Practitioners, Physicians, and RN Care Managers on accurate ICD-10-CM coding, HCC capture, and documentation requirements to support proper Medicare risk adjustment. Review clinical encounter documentation and provide real-time feedback on coding accuracy, specificity, and completeness. Identify coding gaps, missed HCC capture opportunities, and documentation deficiencies across care programs and patient populations. Provide guidance on condition-specific coding requirements for high-prevalence chronic conditions within Avail's patient population (e.g., diabetes, CHF, COPD, CKD, behavioral health diagnoses). Workflow Design & Policy Development Partner with clinical and operational leadership to design and implement coding workflows integrated into Avail's care program delivery model. Develop and maintain coding and documentation policies, guidelines, and standard operating procedures (SOPs) aligned with CMS requirements and Medicare Advantage risk adjustment best practices. Support the development of documentation templates, encounter coding checklists, and structured data capture tools within the EMR and care coordination platforms. Define escalation pathways and quality review workflows for coding discrepancies, queries, and corrections. Education, Training & Provider Support .