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+ yearsof experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations, with at least 2 yearsin a leadership role.
- Deep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCCrisk adjustment methodologies.
- Strong knowledge of ICD-10-CM coding guidelinesas applied to HCC risk adjustment.
- Experience with RADV audit preparationand CMS compliance requirements.
- Familiarity with RAPSand EDGE submission processes.
- Exceptional written and verbal Englishcommunication 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 RHIAcredential.
- Experience with risk adjustment analytics platformsand chart retrieval systems.
- Background in health plan, Medicare Advantage organisation, or value-based care setting.
- Familiarity with AI-assisted HCC coding toolsand 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
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