Remote Risk Adjustment Leader — HCC & AI Coding Expert

mercor; United States; Remote; USD 129,000 - 174,000; Part time

Job summary

Mercor, a remote-friendly lead in AI-powered healthcare risk adjustment, seeks a Risk-adjustment / HCC coding leader. This contract role focuses on overseeing Medicare Advantage, Medicaid, and ACA risk adjustment operations, and aligning AI-generated coding with clinical accuracy and regulatory standards.

You will review medical records, manage retrospective/prospective chart reviews, and lead RADV audit preparation while collaborating with clinical, coding, and compliance teams to enhance

Qualifications

• 5+ years in risk adjustment coding / HCC coding / Medicare Advantage coding operations, with leadership experience.
• Deep expertise in CMS-HCC, RxHCC, or ACA HHS-HCC risk adjustment methodologies.
• Strong knowledge of ICD-10-CM guidelines as applied to HCC risk adjustment.
• Experience with RADV audit preparation and CMS compliance requirements.
• Familiarity with RAPS and EDGE submission processes.
• Exceptional written and verbal English communication skills.
• High attention to detail to identify coding inaccuracies and documentation gaps in AI outputs.

Responsibilities

• Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA risk adjustment programs.
• Evaluate AI-generated HCC coding assignments for clinical accuracy and regulatory compliance.
• Review medical records to ensure complete capture of HCC-eligible conditions supported by documentation.
• Conduct and oversee retrospective and prospective chart reviews for risk score optimization.
• Manage RADV audit preparation and response processes.
• Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes.

Skills

Risk adjustment coding

HCC coding

Medicare Advantage coding

CMS-HCC methodologies

ICD-10-CM guidelines

RADV audit preparation

Regulatory compliance

English communication

Job description

Mercor, a remote-friendly lead in AI-powered healthcare risk adjustment, seeks a Risk-adjustment / HCC coding leader. This contract role focuses on overseeing Medicare Advantage, Medicaid, and ACA risk adjustment operations, and aligning AI-generated coding with clinical accuracy and regulatory standards.

You will review medical records, manage retrospective/prospective chart reviews, and lead RADV audit preparation while collaborating with clinical, coding, and compliance teams to enhance