Talent.com
Mercor
Remote Risk-adjustment / HCC coding leader - AI Trainer ($110-$110 per hour)Mercor • Medford, Massachusetts, US
Remote Risk-adjustment / HCC coding leader - AI Trainer ($110-$110 per hour)

Remote Risk-adjustment / HCC coding leader - AI Trainer ($110-$110 per hour)

Mercor • Medford, Massachusetts, US
30+ days ago
Job type
  • Full-time
  • Remote
Job description
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 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. **Preferred Qualifications** - CRC (Certified Risk Coder), CCS, CPC, or RHIA credential. - Experience with risk adjustment analytics platforms and chart retrieval systems. - Background in health plan, Medicare Advantage organisation, or value-based care setting. - Familiarity with AI-assisted HCC coding tools and comfort evaluating AI-generated risk adjustment content. - Experience presenting risk adjustment performance to actuarial or executive teams. **Why Join?** - Contribute to the development of frontier AI systems in healthcare. - Collaborate with a world-class AI research organisation. - Gain exposure to cutting-edge AI workflows in risk adjustment and value-based care. - Opportunity to work on high-impact projects shaping the future of healthcare AI.
Create a job alert for this search

Remote Risk-adjustment / HCC coding leader - AI Trainer ($110-$110 per hour) • Medford, Massachusetts, US

Similar jobs

Clinical Trial Participants Needed - Earn Up to $4,000 Part-Time

Apex Focus Group LLCHanover, MA, United States
Part-time

Looking to earn extra income while contributing to medical advancements? Explore local clinical trials and get paid up to $4,000 for your participation.No-cost study-related care and medication pro... Show more

 • Promoted

Sr. Manager, AI Enablement

OceansprayjobsLakeville, MA, United States
Full-time

Ocean Spray is hiring for a Sr.Manager, AI Enablement! We're a team of farmers, thinkers, creators, and doers.Whatever your title, whatever your role it always comes back to this: we're a farmer-o... Show more

 • Promoted

Manager, Provider Directory Audit

Tufts Health PlanCanton, MA, United States
Full-time

Manager, Provider Data Quality.The Manager, Provider Data Quality, is responsible for the development and successful oversight of the Point32Health provider directory quality audit program, includi... Show more

 • Promoted

Contracting Analyst

Careers Integrated Resources IncRaynham, MA, United States
Full-time

A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms.IRI has built its reputation on excell... Show more

 • Promoted

VP, Finance - Remote

InsightlyRaynham, MA, United States
Remote
Full-time

VP, Finance - RemoteWe're a results focused, customer-obsessed company motivated by our passion for empowering digital marketers to achieve success with their campaigns.With intuitive landing page ... Show more

 • Promoted

Co-Founder & CEO - AI Clinical Documentation Compliance

FutureSightBoston, MA, United States
Full-time

Co-Founder & CEO Opportunity At Concordance.FutureSight is seeking a Co-Founder & CEO to lead Concordance, an AI-native clinical documentation compliance venture.This is a co-founder partnership wi... Show more

 • Promoted

Lead Practitioner (HITRUST)Latin America (Remote)

Insight AssuranceCambridge, MA, United States
Remote
Full-time

Insight Assurance is a security and compliance firm trusted by over 1200 organizations for their SOC 2, PCI DSS, ISO 27001, and HIPAA audit needs.Insight Assurance is a licensed CPA firm, PCI Quali... Show more

 • Promoted

Fraud Engineer - AI Specialist - AI Trainer

MercorBoston, Massachusetts, United States
$80.00 hourly
Remote
Part-time
Quick Apply

Headquartered in San Francisco, our investors include.Fraud Engineer (Coding Agent Experience).Review model-generated implementations involving fraud detection systems, risk scoring models, abuse p... Show more

Flexible remote AI work. Your schedule. Paid weekly, straight to your bank account.

Meridian.aiNewburyport, MA, US
Remote
Full-time

Review and label digital content including text, images, and documents.Every task you complete helps improve how technology interprets information and performs in practical settings.Detail-oriented... Show more

 • Promoted

Remote Product Tester - Flexible Studies

BuzzTestersBridgewater, MA
Remote
Full-time

Earn up to $400/week, depending on the number and type of studies you complete.Share honest feedback on products and services from independent brands.Assignments include short online surveys (10–20... Show more

 • Promoted

Sr. Audit Specialist

Blue Cross and Blue Shield of MassachusettsRockland, MA, United States
Full-time

Ready to help us transform healthcare? Bring your true colors to blue.Reporting to the Director of Regulatory and PBM Audit, the Senior Auditor is a key member of the team responsible for the facil... Show more

 • Promoted

Survey Taker: Earn up to $25 per survey (Remote)

Earn HausBrockton, MA, US
Remote
Full-time +1

Looking for people to participate in taking online surveys for Fortune 500 brands.All you need to do is complete online surveys by sharing your opinion.You will help influence brand decisions on se... Show more

 • Promoted

Online Survey Participant: Work Remote and Earn Up To $25 Per Survey

Earn HausBrockton, MA, US
Remote
Full-time +1

Looking for people to participate in taking online surveys for Fortune 500 brands.All you need to do is complete online surveys by sharing your opinion.You will help influence brand decisions on se... Show more

 • Promoted

Sr. Mgr. Advanced Analytics & Modeling

OceansprayjobsLakeville, MA, United States
Full-time

Ocean Spray is hiring for a(n) Sr.Advanced Analytics & Modeling! We're a team of farmers, thinkers, creators, and doers.Whatever your title, whatever your role it always comes back to this: we're ... Show more

 • Promoted

Job Director, Artificial Intelligence (AI)

AmetekPeabody, MA, United States
Full-time

Director, Artificial Intelligence (AI).Location: Peabody, MA, US, 01960 Business Unit: Nul Posting Date: Jun 21, 2026.The Director, Artificial Intelligence will lead the UPT division's AI-driven va... Show more

 • Promoted

Medical Coder

Aya HealthcareBrockton, MA, United States
Full-time

Manager Professional Billing Coding Operations Remote.Boston Medical Center (BMC) is more than a hospital.Its a network of support and care that touches the lives of hundreds of thousands of people... Show more