HCC CODING LEADER - RISK ADJUSTMENT

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 organization, 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: 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.