Key Facts

Remote From:

New York (USA)

Part time

English

Hard Skills

Risk Adjustment Coding (RAC) ICD Coding (ICD-9/ICD-10) Risk Analytics Chart Abstraction

Other Skills

•
Communication
•
Detail Oriented

Roles & Responsibilities

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.

Requirements:

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.

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.

Application Process (Takes 20–30 mins to complete)

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Resources & Support

For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome
For any help or support, reach out to: support@mercor.com

PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.

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