Risk Adjustment Expert - Fully Remote | Upto $110/hr

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

About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey . Position: Risk-adjustment / HCC coding leader Type: Contract Compensation: $110/hour Location: Remote

Role 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 optimization.
• Manage RADV audit preparation and response processes.
• Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes.

Qualifications

Must-Have

• 5+ years of experience in risk adjustment coding , HCC 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 .
• Exceptional written and verbal English communication skills.
• High attention to detail with the ability to identify coding inaccuracies and documentation gaps in AI-generated outputs .

Preferred

• CRC (Certified Risk Coder) , CCS , CPC , or RHIA credential.
• Experience with risk adjustment analytics platforms and chart retrieval systems.
• Background in health plan, Medicare Advantage organisation , or value-based care setting.
• Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content .
• Experience presenting risk adjustment performance to actuarial or executive teams.