Risk-adjustment / HCC coding leader

About this role

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Risk Adjustment and HCC Coding leaders to evaluate AI tools designed to improve risk score accuracy and coding completeness in Medicare Advantage, Medicaid managed care, and ACA markets. Your expertise in hierarchical condition category (HCC) methodology, RADV audit preparation, and risk adjustment coding will directly shape AI systems that enhance documentation capture and risk score integrity. **Responsibilities** - Lead risk adjustment and HCC coding operations across Medicare Advantage, Medicaid, and/or 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 optimisation. - Manage RADV (Risk Adjustment Data Validation) audit preparation and response processes. - Monitor risk adjustment KPIs including HCC capture rates, risk score accuracy, and chart retrieval rates. - Collaborate with clinical, coding, and compliance teams to improve documentation and coding for risk adjustment purposes. - Ensure compliance with CMS risk adjustment guidelines (RAPS, EDGE submissions) and Official Coding Guidelines. - Annotate AI outputs and provide structured coding feedback to support AI training datasets. **Requirements** - 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 prepara