Remote HCC Coding & Risk-Adjustment Lead

Mercor; New York (NY); On-site; USD 151,536 - 206,640; Part time

Job summary

Mercor is seeking a Risk-Adjustment/HCC coding leader to oversee coding operations for Medicare Advantage and Medicaid programs. The ideal candidate will have over 5 years of experience in risk adjustment coding and must exhibit deep expertise in CMS-HCC and ICD-10-CM guidelines.

This role is focused on evaluating AI-generated coding for accuracy and compliance, leading teams, and managing audits. Strong communication skills are essential as the position demands collaboration with various healthcare teams.

Qualifications

• 5+ years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations.
• Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologies.
• Strong knowledge of ICD-10-CM coding guidelines as applied to HCC risk adjustment.

Responsibilities

• Lead risk adjustment and HCC coding operations across Medicare Advantage and Medicaid programs.
• Evaluate AI-generated HCC coding assignments for clinical accuracy and compliance.
• Conduct retrospective and prospective chart reviews for risk score optimization.

Skills

Risk adjustment coding

HCC coding

ICD-10-CM coding guidelines

RADV audit preparation

Communication

Education

CRC (Certified Risk Coder)

CCS

CPC

RHIA

Job description

Mercor is seeking a Risk-Adjustment/HCC coding leader to oversee coding operations for Medicare Advantage and Medicaid programs. The ideal candidate will have over 5 years of experience in risk adjustment coding and must exhibit deep expertise in CMS-HCC and ICD-10-CM guidelines.

This role is focused on evaluating AI-generated coding for accuracy and compliance, leading teams, and managing audits. Strong communication skills are essential as the position demands collaboration with various healthcare teams.