Risk Adjustment AI Trainer & Lead

Obsidian; Nashville (TN); On-site; USD 120,000 - 230,000; Full time

Job summary

Mercor is partnering with a leading AI research lab to build risk adjustment capabilities across Medicare Advantage, Medicaid, and ACA markets. We seek experienced Risk Adjustment and HCC Coding leaders to guide AI tool evaluation and ensure documentation capture and coding integrity.

You will lead risk adjustment operations, oversee RADV prep, monitor KPIs, and collaborate with clinical, coding and compliance teams to align CMS guidelines and AI outputs for training data.

Qualifications

• 5+ years of experience in risk adjustment coding or Medicare Advantage coding operations, with at least 2 years in a leadership role.
• 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.
• 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 risk adjustment programs.
• Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy and regulatory compliance.
• Review medical records to ensure complete and accurate capture of HCC-eligible conditions supported by clinical documentation.
• Conduct and oversee retrospective and prospective chart reviews for risk score optimisation.
• Manage RADV audit preparation and response processes.
• Monitor risk adjustment KPIs including HCC capture rates, risk score accuracy, and chart retrieval rates.
• Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes.
• Ensure compliance with CMS risk adjustment guidelines (RAPS, EDGE submissions) and Official Coding Guidelines.
• Annotate AI outputs and provide structured coding feedback to support AI training datasets.

Skills

Leadership experience

CMS-HCC risk adjustment

HCC coding

RADV audit preparation

ICD-10-CM guidelines

Regulatory compliance

Risk adjustment analytics

Education

CRC (Certified Risk Coder)

CCS

CPC

RHIA

Tools

RADV audit tools

Chart retrieval systems

Job description

Mercor is partnering with a leading AI research lab to build risk adjustment capabilities across Medicare Advantage, Medicaid, and ACA markets. We seek experienced Risk Adjustment and HCC Coding leaders to guide AI tool evaluation and ensure documentation capture and coding integrity.

You will lead risk adjustment operations, oversee RADV prep, monitor KPIs, and collaborate with clinical, coding and compliance teams to align CMS guidelines and AI outputs for training data.