Risk adjustment is no longer a revenue optimization function. It is an enterprise discipline requiring operational precision and defensible infrastructure.
As audit activity accelerates, retrospective lift strategies are becoming less reliable and less defensible. Performance now depends on integrated workflows, compliant documentation and aligned operations.
At ProspHire, we strengthen the operational backbone of risk adjustment programs, building performance designed to hold under audit.
What We Do
✔ Compliance program effectiveness
✔ Prospective risk capture and provider enablement
✔ Regulatory audit planning and response
✔ Documentation and encounter strategy redesign
✔ Stars and RAF alignment
✔ Financial rigor and cost alignment
We focus on durable, defensible revenue capture, not short-term lift.
The Shift
Retrospective lift alone will not sustain performance.
Organizations succeeding in this environment are:
• Integrating compliance and risk operations
• Strengthening documentation at the point of care
• Stress-testing RAF under audit conditions
This is the shift from revenue recovery to revenue integrity.
Outcomes
✔ Improved audit defensibility
✔ Increased prospective RAF capture
✔ Reduced compliance exposure
✔ More predictable revenue performance
Focused Execution. Measurable Impact.
Risk adjustment performance isn’t just about capturing codes.
It’s about building operational infrastructure that delivers sustainable financial accuracy and regulatory confidence.
How ProspHire Can Help
See how ProspHire can help address the key issues facing your organization.
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Risk Adjustment Program Best Practices
Drive organizational transformation through defined goals and a developed playbook for change management and actionable strategies to build a best-in-class Risk Adjustment program.
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Encounter Submission Program Evaluation
Receive guidance and areas of opportunity to achieve optimal capture of diagnosis codes with HCC impact and incremental value accepted and stored by CMS.
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Retrospective Program Evaluation
Maximize the value from chart retrieval and coding efforts through targeted gap identification and appropriate vendor selection for the desired medical record review method.
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Prospective Program Evaluation
Evaluate current activity effectiveness to determine the best suited prospective provider and member engagement programs for annual member diagnosis code recapture.
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Vendor Effectiveness Evaluation
Assess vendor performance against contract service agreements, industry best-in-class standards and standards of delivery quality.
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Program and Project Management
Realize value faster with skilled program and project managers who will relieve leaders of administrative burden and organizing teams to execute the project plan efficiently and effectively.
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Staff Augmentation
Provide talented, experienced subject matter experts to fill temporary staffing gaps to support additional business needs such as RFP execution, vendor management, or vendor implementations.
Client Results
