Lead Risk Adjustment & HCC Coding for AI Systems

Mercor; New York (NY); Remote; USD 150,000 - 230,000; Full time

Job summary

Mercor seeks experienced Risk Adjustment and HCC Coding leaders to guide AI-enabled risk capture improvements for Medicare Advantage, Medicaid managed care, and ACA markets. You will evaluate AI outputs, oversee chart reviews, and drive regulatory compliance across CMS guidelines.

You will collaborate with clinical, coding, and compliance teams to optimize documentation capture and risk score accuracy, while leading RADV preparedness and KPI monitoring in a fast-paced AI research environment.

Qualifications

• 5+ years in risk adjustment coding with at least 2 years in a leadership role.
• Deep expertise in CMS-HCC, RxHCC and ACA HHS-HCC methodologies.
• Strong knowledge of ICD-10-CM coding guidelines for HCC risk adjustment.

Responsibilities

• Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and/or ACA programs.
• Evaluate AI-generated HCC coding and risk adjustment recommendations for accuracy and compliance.
• Review medical records to ensure complete capture of HCC-eligible conditions.
• Conduct chart reviews for risk score optimization and oversee RADV audit prep.

Skills

Risk adjustment leadership

HCC coding

CMS-HCC knowledge

Regulatory compliance

Medical records review

RADV audit

Education

CRC/CCS/CPC/RHIA credentials

Health plan / MA knowledge

Tools

Risk adjustment analytics platforms

Chart retrieval systems

Job description

Mercor seeks experienced Risk Adjustment and HCC Coding leaders to guide AI-enabled risk capture improvements for Medicare Advantage, Medicaid managed care, and ACA markets. You will evaluate AI outputs, oversee chart reviews, and drive regulatory compliance across CMS guidelines.

You will collaborate with clinical, coding, and compliance teams to optimize documentation capture and risk score accuracy, while leading RADV preparedness and KPI monitoring in a fast-paced AI research environment.