[Hiring] Risk Adjustment Expert @Mercor

Role Description

• 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

• 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.

Company Description