Risk Adjustment & HCC Coding Director | Remote

Type: Hourly contract
Compensation: $110 per hour
Location: Remote
Commitment: 10-40 hrs/week

Responsibilities

• 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 optimisation.
• Manage RADV 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 and Official Coding Guidelines.
• Annotate AI outputs and provide structured coding feedback to support AI training datasets.

Requirements

• Strong relevant experience in risk adjustment coding, HCC coding, or Medicare Advantage coding operations.
• 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.