Remote AI-Driven Risk-Adjustment & HCC Lead

Modern MedEd; United States; Remote; USD 120,000 - 180,000; Full time

Job summary

Mercor is seeking a Senior Risk Adjustment and HCC Coding leader to direct operations across Medicare Advantage, Medicaid, and ACA programs. You will evaluate AI-generated HCC coding and risk adjustment recommendations for clinical accuracy and regulatory compliance.

You will review medical records, oversee chart reviews, manage RADV audit preparation, monitor KPI like capture rates and score accuracy, and collaborate with clinical and compliance teams to improve documentation and coding aligned

Qualifications

• 5+ years in risk adjustment coding or Medicare Advantage coding operations
• 2+ years in leadership role
• Deep CMS-HCC, RxHCC, or ACA HHS-HCC expertise
• Strong ICD-10-CM knowledge for HCC risk adjustment
• Experience with RADV audits and CMS compliance
• Familiarity with RAPS and EDGE submissions
• Excellent written and verbal English communication
• Attention to detail identifying coding inaccuracies

Responsibilities

• Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA programs
• Evaluate AI-generated HCC coding for clinical accuracy and regulatory compliance
• Review medical records to capture HCC-eligible conditions
• Conduct chart reviews for risk score optimization
• Manage RADV audit preparation and responses
• Monitor KPIs like HCC capture rates and risk scores
• Collaborate with clinical, coding, and compliance teams
• Ensure CMS risk adjustment guidelines compliance
• Annotate AI outputs to provide structured feedback for training datasets

Skills

Risk adjustment

HCC coding

CMS guidelines

English communication

Medicare Advantage

Tools

Risk adjustment analytics platforms

Chart retrieval systems

Job description

Mercor is seeking a Senior Risk Adjustment and HCC Coding leader to direct operations across Medicare Advantage, Medicaid, and ACA programs. You will evaluate AI-generated HCC coding and risk adjustment recommendations for clinical accuracy and regulatory compliance.

You will review medical records, oversee chart reviews, manage RADV audit preparation, monitor KPI like capture rates and score accuracy, and collaborate with clinical and compliance teams to improve documentation and coding aligned