HCC Coding Leader for AI Risk Adjustment

Mercor; San Francisco (CA); On-site; USD 180,000 - 240,000; Full time

Job summary

Mercor is seeking an experienced Risk Adjustment and HCC Coding leader to drive operations across Medicare Advantage, Medicaid, and ACA programs. You will evaluate AI-generated coding for accuracy and regulatory compliance, review records for complete HCC capture, and oversee RADV audit preparation.

You will collaborate with clinical, coding, and compliance teams to improve documentation quality and ensure CMS guideline adherence, while monitoring KPIs such as capture rates and chart retrieval.

Qualifications

• 5+ years in risk adjustment coding or Medicare Advantage coding operations, with leadership experience.
• Deep expertise in CMS-HCC, RxHCC, or ACA HHS-HCC models.
• Strong knowledge of ICD-10-CM guidelines as applied to HCC risk adjustment.
• Experience with RADV audit prep and CMS compliance requirements.
• Familiarity with RAPS and EDGE submission processes.

Responsibilities

• Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA programs.
• Evaluate AI-generated HCC coding assignments for clinical accuracy and regulatory compliance.
• Review medical records to ensure complete and accurate capture of HCC-eligible conditions.
• Conduct retrospective and prospective chart reviews for risk score optimization.
• Manage RADV audit preparation and response processes.
• Monitor risk adjustment KPIs including HCC capture rates and chart retrieval.
• Collaborate with clinical, coding, and compliance teams to improve documentation.
• Ensure compliance with CMS risk adjustment guidelines and Official Coding Guidelines.
• Annotate AI outputs and provide structured coding feedback for AI training datasets.

Skills

HCC coding leadership

CMS-HCC risk adjustment

RADV audit experience

ICD-10-CM knowledge

English communication

Chart review quality

Tools

RADV tools

Chart retrieval systems

Analytics platforms

Job description

Mercor is seeking an experienced Risk Adjustment and HCC Coding leader to drive operations across Medicare Advantage, Medicaid, and ACA programs. You will evaluate AI-generated coding for accuracy and regulatory compliance, review records for complete HCC capture, and oversee RADV audit preparation.

You will collaborate with clinical, coding, and compliance teams to improve documentation quality and ensure CMS guideline adherence, while monitoring KPIs such as capture rates and chart retrieval.