Risk-adjustment / HCC coding leader | $110/hr Remote
Overview
This remote, hourly role is perfect for an experienced risk adjustment and HCC coding leader. You'll partner with a top-tier AI research lab to evaluate and improve AI tools that boost risk score accuracy and documentation completeness. Your deep knowledge of HCC methodology, CMS compliance, and RADV audits will directly influence how AI models handle hierarchical condition categories across Medicare Advantage, Medicaid, and ACA programs. Bring your leadership experience and clinical coding expertise to a project that sits at the intersection of healthcare and frontier AI.
What You'll Do9
- 1Steer risk adjustment and HCC coding operations for Medicare Advantage, Medicaid managed care, and ACA health plans.
- 2Assess AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy and adherence to regulations.
- 3Review patient medical records to confirm that all HCC-eligible conditions are fully and accurately documented.
- 4Run both retrospective and prospective chart reviews to maximize risk score accuracy and optimize documentation.
- 5Lead the planning and execution of RADV audit preparation, including responding to audit requests.
- 6Track and analyze key risk adjustment metrics, such as HCC capture rates, risk score accuracy, and chart retrieval performance.
- 7Work alongside clinical, coding, and compliance teams to enhance documentation practices and coding for risk adjustment.
- 8Ensure all work aligns with CMS risk adjustment rules, including RAPS and EDGE submissions, plus Official Coding Guidelines.
- 9Provide structured coding feedback and annotate AI outputs to help train and refine AI datasets.
Requirements11
- 1At least 5 years of experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations, including 2+ years in a leadership capacity.
- 2Strong command of CMS-HCC, RxHCC, and ACA HHS-HCC risk adjustment methodologies.
- 3Solid knowledge of ICD-10-CM coding guidelines as they apply to HCC risk adjustment.
- 4Demonstrated experience with RADV audit preparation and meeting CMS compliance requirements.
- 5Familiarity with RAPS and EDGE submission workflows.
- 6Excellent written and verbal communication skills in English.
- 7A meticulous eye for detail, with the ability to spot coding errors and documentation gaps in AI-generated outputs.
- 8Preferred: CRC, CCS, CPC, or RHIA certification.
- 9Preferred: Experience with risk adjustment analytics platforms, chart retrieval systems, or working in a health plan, Medicare Advantage organization, or value-based care setting.
- 10Preferred: Comfort evaluating AI-assisted HCC coding tools and providing feedback on AI-generated risk adjustment content.
- 11Preferred: Experience presenting risk adjustment performance to actuarial or executive teams.
Who Should Apply
You're a seasoned risk adjustment leader who knows the ins and outs of HCC coding, CMS regulations, and RADV audits — and you're excited to apply that expertise to AI development. You thrive on detail and can quickly identify where AI-generated coding assignments fall short. You've led teams, improved chart capture rates, and collaborated across clinical and technical stakeholders. If you're comfortable guiding AI systems and eager to shape the future of healthcare AI, this role is for you.
Salary Insight
The compensation is $110.00 per hour on a remote, contract basis.
Location
Required Skills
Application Tip
In your application, include a concrete example of a time you improved HCC capture rates or successfully navigated a RADV audit — with specific numbers or outcomes. This shows you can deliver measurable impact, which is exactly what the AI evaluation work requires.
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