Risk Adjustment Expert - Fully Remote

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

• 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.

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.

• 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.