Lead HCC Coding & Risk Adjustment in AI Health Tech

Obsidian; San Francisco (CA); On-site; USD 170,000 - 210,000; Full time

Job summary

Mercor is seeking an experienced Risk Adjustment and HCC Coding leader to guide operations across Medicare Advantage, Medicaid, and ACA programs. You will review AI-generated risk adjustments, ensure regulatory compliance, and oversee RADV audit prep.

A strong background in CMS-HCC/ACA methodologies, ICD-10-CM, and documentation insights is essential. You will collaborate with clinical, coding, and compliance teams to improve data capture, coding accuracy, and risk score integrity while guiding

Qualifications

• 5+ years in risk adjustment coding or Medicare Advantage coding operations, with leadership experience.
• Deep expertise in CMS-HCC, RxHCC and ACA HHS-HCC risk adjustment methodologies.
• Strong knowledge of ICD-10-CM guidelines for HCC risk adjustment.
• Experience with RADV audit preparation 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 capture of HCC-eligible conditions.
• Conduct chart reviews for risk score optimization.
• Manage RADV audit preparation and response processes.
• Monitor KPIs such as HCC capture rates and chart retrieval rates.
• Collaborate with clinical, coding and compliance teams to improve documentation and coding.
• Ensure CMS risk adjustment guidelines and Official Coding Guidelines are followed.
• Annotate AI outputs and provide structured coding feedback for training datasets.

Skills

Risk adjustment coding

CMS-HCC

RADV audit

RAPS & EDGE

Clinical documentation review

Education

CRC/CCS/CPC/RHIA credential

Tools

Risk adjustment analytics platforms

Chart retrieval systems

Job description

Mercor is seeking an experienced Risk Adjustment and HCC Coding leader to guide operations across Medicare Advantage, Medicaid, and ACA programs. You will review AI-generated risk adjustments, ensure regulatory compliance, and oversee RADV audit prep.

A strong background in CMS-HCC/ACA methodologies, ICD-10-CM, and documentation insights is essential. You will collaborate with clinical, coding, and compliance teams to improve data capture, coding accuracy, and risk score integrity while guiding