modxuser In my opinion and experience, well coded + semantic markup is what SEO should be about and that is also what works the best for my clients. That is actually why I love to use Evo, because it is so easy to change the webpage as I need; doing similar feats is largely impossible with e.g. Wordpress.
I have never seen fine-tunings such as keyword densities work beyond what could be considered random chance. If one wants to venture beyond the well coded part of SEO, then there are other things that actually work and make sense: for example at the moment I am working one adding FAQ sections with markup to relevant pages on one website. The reason is simple: average page on that website has 5% click-through-rate in Google, but page with FAQ has about 10% click-through-rate and better ranking. I got the numbers from last 12 month averages and one can see that this effect is not random according to the data. And I think this is what advanced SEO should consist of - crunching the numbers and finding opportunities where one can improve the usability or indexability of the webpage. And this can easily be run every 6 months/once a year to identify opportunities and plan improvements, based on available budget.
Of course, there is then off-page SEO, but this is very hard to pull of in a way that works. Yes, you can be getting some links, but valuable links are hard to come by, especially for business websites. There are sensible things to do, such as searching NAP (name, address, phone) to find mentions of the business and get links, or reverse image search, or just monitoring whether someone didn't copy your content. Apart from that there are link farms and other black hat things that do more harm in the long run. Or you can spam random web forums with links to the website. And I think this is where most time is spent, but usually with marginal gains.