Risk-adjustment / HCC coding leader | $110/hr Remote
Overview
We're looking for an experienced Risk Adjustment and HCC coding leader to help shape the next generation of AI healthcare tools. In this remote, hourly role, you'll audit AI-generated coding assignments, oversee risk adjustment operations across Medicare Advantage and ACA programs, and ensure compliance with CMS guidelines. Your expertise will directly improve how AI systems capture and validate diagnostic codes.
What You'll Do9
- 1Direct risk adjustment and HCC coding efforts for Medicare Advantage, Medicaid, and ACA lines of business.
- 2Assess AI-produced HCC code recommendations for clinical accuracy and alignment with regulatory standards.
- 3Examine medical records to confirm all HCC-eligible conditions are fully documented and coded.
- 4Oversee both retrospective and prospective chart reviews to maximize risk score accuracy.
- 5Manage the full RADV audit lifecycle, including preparation, response, and documentation gathering.
- 6Track key metrics like HCC capture rates, risk score fidelity, and chart retrieval success.
- 7Work alongside clinical, coding, and compliance teams to improve documentation practices and coding completeness.
- 8Ensure adherence to CMS risk adjustment rules for RAPS and EDGE submissions as well as official ICD-10-CM guidelines.
- 9Provide structured feedback on AI outputs and annotate examples to train the underlying models.
Requirements7
- 1At least 5 years working in risk adjustment coding, HCC coding, or Medicare Advantage operations, with a minimum of 2 years in a leadership capacity.
- 2Deep understanding of CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment models.
- 3Solid command of ICD-10-CM coding guidelines as they apply to HCC risk adjustment.
- 4Proven experience with RADV audit preparation and CMS compliance workflows.
- 5Familiarity with RAPS and EDGE submission processes.
- 6Excellent written and verbal English communication skills.
- 7A sharp eye for detail, especially when spotting coding errors or documentation gaps in AI-generated outputs.
Who Should Apply
This role is ideal for a seasoned risk adjustment leader who thrives at the intersection of healthcare compliance and AI innovation. You're comfortable evaluating outputs from AI systems, have deep hands-on knowledge of HCC methodology, and can communicate confidently with clinical, coding, and executive teams. A CRC, CCS, CPC, or RHIA credential is a strong plus.
Salary Insight
The position pays $110.00 per hour, with no mention of benefits or full-time conversion.
Application Tip
When applying, emphasize your hands-on experience with RADV audits and CMS compliance, and if you've worked with AI-assisted coding tools or analytics platforms, make that front and center. A concrete example of how you improved HCC capture rates will set you apart.
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