Risk Adjustment Expert - Fully Remote | Upto $110/hr
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)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check:
- For any help or support, reach out to:
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Originally posted on Himalayas