Remote | HCC Risk Adjustment Coding Consultant — Up to $85​/hour

Specialised Part-Time Consulting Opportunity

We are sharing a specialised part-time consulting opportunity for United States-based healthcare coding and risk adjustment professionals experienced in HCC coding, Medicare Advantage risk adjustment, Medicaid managed care, ACA risk adjustment, RADV audit preparation, medical record review, documentation capture, and coding compliance.

This role supports current and upcoming remote consulting opportunities focused on AI-assisted risk adjustment coding evaluation, HCC recommendation review, documentation completeness assessment, and high-quality project execution. Selected professionals will apply coding and risk adjustment expertise to evaluate AI-generated HCC assignments, review documentation support, identify coding inaccuracies, and provide structured feedback based on detailed project criteria.

Professionals in this role may contribute to:

• Risk Adjustment & HCC Coding Review
• Chart Review, RADV & Risk Score Evaluation
• Structured Coding Feedback & Quality Control

• Review risk adjustment coding workflows across Medicare Advantage, Medicaid managed care, and ACA risk adjustment programs
• Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy, documentation support, and regulatory compliance
• Review medical records to determine whether HCC-eligible conditions are fully and accurately supported by clinical documentation
• Identify coding inaccuracies, unsupported diagnoses, documentation gaps, missed HCC opportunities, and compliance concerns

• Assess retrospective and prospective chart review outputs for completeness, accuracy, and risk score relevance
• Evaluate outputs related to CMS-HCC, RxHCC, and ACA HHS-HCC methodologies
• Support review of RADV audit preparation, audit response workflows, and risk adjustment data validation requirements
• Review risk adjustment KPIs such as HCC capture rates, risk score accuracy, chart retrieval rates, and coding quality indicators

• Annotate AI-generated coding and risk adjustment outputs and provide structured feedback to support quality improvement
• Explain review decisions clearly, consistently, and with strong coding and compliance judgment
• Evaluate outputs for alignment with CMS risk adjustment guidance, ICD-10-CM coding standards, Official Coding Guidelines, RAPS, EDGE submissions, and applicable compliance expectations
• Follow detailed task instructions, quality criteria, and project-specific review guidelines accurately

Strong candidates may have:

• 5+ years of experience in risk adjustment coding, HCC coding, Medicare Advantage coding operations, or related healthcare coding workflows
• At least 2 years of leadership experience in risk adjustment, HCC coding, coding quality, chart review, or coding operations
• 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 risk adjustment and HCC documentation
• Experience with RADV audit preparation, CMS compliance requirements, chart retrieval workflows, and risk adjustment quality review
• Familiarity with RAPS and EDGE submission processes
• Exceptional written and verbal English communication skills
• High attention to detail and ability to identify coding inaccuracies, unsupported diagnoses, and documentation gaps in AI-generated outputs

Professional background in risk adjustment coding, HCC coding, medical coding, health information management, Medicare Advantage operations, managed care coding, value-based care, or coding compliance is highly relevant

• Experience in health plans, Medicare Advantage organizations, Medicaid managed care organizations, provider groups, value-based care organizations, or coding vendor environments may be especially valuable
• Practical experience with chart review systems, coding platforms, risk adjustment analytics tools, EHR documentation, and audit workflows may support project fit
• Formal education or training in health information management, medical coding,…