Risk Adjustment and HCC Coding Reviewer

OpenTrain AI; Northern (KY); Hybrid; USD 125,000 - 178,000; Part time

Job summary

OpenTrain AI is seeking an experienced Risk Adjustment and HCC Coding Reviewer to evaluate AI tools for risk score accuracy and documentation in healthcare settings. The role focuses on Medicare Advantage, Medicaid, and ACA risk adjustment workflows, with the reviewer validating AI-generated coding against medical records and supporting RADV activities.

The contractor will provide structured feedback, lead chart reviews, and collaborate with clinical and compliance teams to improve AI training

Qualifications

• Five+ years in risk adjustment coding, HCC coding, or Medicare Advantage coding operations.
• Two+ years in a leadership role.
• Deep knowledge of CMS-HCC, RxHCC, or ACA HHS-HCC methodologies.
• Strong understanding of ICD-10-CM coding guidelines for HCC risk adjustment.
• Experience with RADV audit prep and CMS compliance requirements.
• Familiarity with RAPS and EDGE submission processes.
• Experience evaluating HCC coding accuracy against medical documentation.

Responsibilities

• Review AI-generated HCC coding recommendations for clinical accuracy and regulatory compliance.
• Examine medical records to confirm HCC-eligible conditions are supported by documentation.
• Lead retrospective and prospective chart review work for risk-score optimization.
• Support RADV audit preparation and response processes.
• Monitor HCC capture rates, risk scores, and chart retrieval performance.
• Collaborate with clinical, coding, and compliance stakeholders on documentation improvements.
• Apply CMS risk adjustment guidance including RAPS and EDGE submission requirements.
• Annotate AI outputs with structured feedback for AI training datasets.

Skills

Risk adjustment coding

HCC coding

Medicare Advantage coding

Leadership

CMS guidelines

English communication

Education

CRC, CCS, CPC, or RHIA credential

Tools

RADV audit processes

Job description

About OpenTrain

OpenTrain is the #1 platform for finding and building careers in AI training and data labeling. OpenTrain AI hires and contracts contributors for specialized projects where expert human judgment helps improve artificial intelligence.

Creating an OpenTrain account is free, and qualified professionals can build a profile and apply in minutes.

About AI Training Work

AI training is the human side of building modern AI systems. Specialists review model outputs, identify errors, and provide structured feedback that helps AI tools become more accurate, reliable, and useful.

In this role, your healthcare risk adjustment expertise will help evaluate AI-generated HCC coding and produce high-quality training data for healthcare applications.

The Role

OpenTrain AI is seeking an experienced Risk Adjustment and HCC Coding Reviewer to evaluate AI tools for risk score accuracy, coding completeness, and documentation capture in healthcare settings.

The work focuses on Medicare Advantage, Medicaid managed care, and ACA risk adjustment workflows. You will review AI-generated HCC coding assignments, compare medical records with clinical documentation, support chart review and RADV audit activities, and provide structured feedback for AI training datasets.

• Contractor, part-time engagement
• 20+ hours per week
• Remote work for candidates in the United States
• English-language work
• Pay: $110 USD per hour
• Expert-level experience required

What You'll Do

You will combine detailed medical record review, HCC coding expertise, CMS guidance, and clear written feedback to assess both AI performance and supporting documentation.

• Review AI-generated HCC coding recommendations for clinical accuracy and regulatory compliance.
• Examine medical records to confirm that HCC-eligible conditions are supported by documentation.
• Lead retrospective and prospective chart review work for risk score optimization.
• Support RADV audit preparation and response processes.
• Monitor HCC capture rates, risk score accuracy, and chart retrieval performance.
• Collaborate with clinical, coding, and compliance stakeholders on documentation improvement.
• Apply CMS risk adjustment guidance, including RAPS and EDGE submission requirements.
• Annotate AI outputs with structured feedback for AI training datasets.

Required Qualifications

This role requires substantial experience in risk adjustment coding and healthcare documentation review, along with the judgment to assess AI-generated recommendations against clinical and regulatory standards.

• At least 5 years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations.
• At least 2 years of leadership experience.
• Deep knowledge of CMS-HCC, RxHCC, and/or ACA HHS-HCC methodologies.
• Strong understanding 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.
• Experience evaluating HCC coding accuracy against medical documentation.
• Strong written and verbal English communication skills.
• Close attention to coding inaccuracies and documentation gaps.

Helpful Background

The following experience or credentials can strengthen your application, although the core requirements above define the role.

• CRC, CCS, CPC, or RHIA credential.
• Experience with risk adjustment analytics platforms or chart retrieval systems.
• Background in a health plan, Medicare Advantage organization, or value-based care setting.
• Familiarity with AI-assisted HCC coding tools.
• Experience presenting risk adjustment performance to actuarial or executive teams.