Risk Adjustment / HCC Coding Leader

$110/hr

50 people hired

RemoteUSTechnology5-8 YearsContractPosted Aug 13, 2026

About this role

You will support the evaluation and improvement of AI systems focused on risk adjustment, HCC coding, documentation capture, and risk-score accuracy across Medicare Advantage, Medicaid managed care, and ACA programs. The role combines senior coding leadership with AI quality evaluation, requiring deep expertise in HCC methodologies, medical record review, RADV audits, and regulatory compliance. You will review AI-generated coding recommendations, identify documentation or coding gaps, and provide structured feedback to improve next-generation healthcare AI systems.

Responsibilities

Risk adjustment leadership: Lead HCC coding and risk adjustment operations across Medicare Advantage, Medicaid, and/or ACA programs.
AI coding evaluation: Review AI-generated HCC assignments and risk-adjustment recommendations for clinical accuracy and regulatory compliance.
Medical record review: Ensure HCC-eligible conditions are accurately captured and supported by clinical documentation.
Chart review management: Conduct or oversee retrospective and prospective chart reviews to improve coding completeness and risk-score accuracy.
RADV audit support: Manage preparation, documentation, validation, and response activities for Risk Adjustment Data Validation audits.
KPI monitoring: Track HCC capture rates, risk-score accuracy, chart retrieval rates, and related performance indicators.
Cross-functional collaboration: Work with clinical, coding, compliance, and revenue teams to improve documentation and coding quality.
Regulatory compliance: Ensure adherence to CMS risk-adjustment requirements, RAPS and EDGE submission processes, and Official Coding Guidelines.
AI training support: Annotate AI outputs and provide structured coding feedback for AI training datasets.

Qualifications

Minimum 5+ years of experience in risk adjustment coding, HCC coding, Medicare Advantage coding, or related healthcare coding operations.
At least 2 years in a leadership or management 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 risk adjustment.
Experience with RADV audit preparation, response, and CMS compliance requirements.
Familiarity with RAPS and EDGE submission processes.
Strong medical record review skills with the ability to identify unsupported diagnoses, missing documentation, and coding inaccuracies.
Exceptional written and verbal English communication skills.
High attention to detail and ability to critically evaluate AI-generated coding and risk-adjustment outputs.
Must be based in the United States.