Senior Risk Adjustment & AI Training Lead

Mercor; Nashville (TN); On-site; USD 140,000 - 190,000; Full time

Job summary

Mercor is partnering with a leading AI research lab to advance risk adjustment processes for Medicare Advantage, Medicaid managed care, and ACA markets. We seek experienced leaders to drive HCC coding, risk score accuracy, and documentation capture across programs.

You will evaluate AI-generated coding, review records, oversee RADV prep, monitor KPIs, and collaborate with clinical, coding, and compliance teams to ensure CMS guidelines compliance and high-quality AI outputs.

Qualifications

• 5+ years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations.
• At least 2 years in a leadership role.
• Deep expertise in CMS-HCC, RxHCC, and ACA HHS-HCC risk adjustment methodologies.
• Strong knowledge of ICD-10-CM guidelines for HCC risk adjustment.
• Experience with RADV audit preparation and CMS compliance requirements.

Responsibilities

• Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and ACA programs.
• Evaluate AI-generated HCC coding assignments for clinical accuracy and regulatory compliance.
• Review medical records to ensure complete and accurate capture of HCC-eligible conditions.
• 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 and risk score accuracy.
• Collaborate with clinical, coding, and compliance teams to improve documentation.
• Ensure CMS risk adjustment guidelines and Official Coding Guidelines are followed.
• Annotate AI outputs to provide structured coding feedback for AI training datasets.

Skills

Risk adjustment leadership

HCC coding expertise

CMS-HCC knowledge

ICD-10-CM guidelines

English communication

Education

CRC (Certified Risk Coder)

CCS

CPC

RHIA

Tools

Risk adjustment analytics platforms

Chart retrieval systems

Job description

Mercor is partnering with a leading AI research lab to advance risk adjustment processes for Medicare Advantage, Medicaid managed care, and ACA markets. We seek experienced leaders to drive HCC coding, risk score accuracy, and documentation capture across programs.

You will evaluate AI-generated coding, review records, oversee RADV prep, monitor KPIs, and collaborate with clinical, coding, and compliance teams to ensure CMS guidelines compliance and high-quality AI outputs.