Remote | HCC Risk Adjustment Coding Consultant — Up to $85/hour
About The Position
We are sharing a specialised part-time consulting opportunity for United States-based healthcare coding and risk adjustment professionals experienced in HCC coding, Medicare Advantage risk adjustment, Medicaid managed care, ACA risk adjustment, RADV audit preparation, medical record review, documentation capture, and coding compliance. This role supports current and upcoming remote consulting opportunities focused on AI-assisted risk adjustment coding evaluation, HCC recommendation review, documentation completeness assessment, and high-quality project execution. Selected professionals will apply coding and risk adjustment expertise to evaluate AI-generated HCC assignments, review documentation support, identify coding inaccuracies, and provide structured feedback based on detailed project criteria.
Requirements
- 5+ years of experience in risk adjustment coding, HCC coding, Medicare Advantage coding operations, or related healthcare coding workflows
- At least 2 years of leadership experience in risk adjustment, HCC coding, coding quality, chart review, or 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 risk adjustment and HCC documentation
- Experience with RADV audit preparation, CMS compliance requirements, chart retrieval workflows, and risk adjustment quality review
- Familiarity with RAPS and EDGE submission processes
- Exceptional written and verbal English communication skills
- High attention to detail and ability to identify coding inaccuracies, unsupported diagnoses, and documentation gaps in AI-generated outputs
- Professional background in risk adjustment coding, HCC coding, medical coding, health information management, Medicare Advantage operations, managed care coding, value-based care, or coding compliance is highly relevant
- Formal education or training in health information management, medical coding, healthcare administration, nursing, clinical documentation, or a related healthcare field may be relevant depending on project scope
Nice To Haves
- CRC, CCS, CPC, RHIA, or similar coding or health information credential
- Experience with risk adjustment analytics platforms, chart retrieval systems, coding quality tools, or AI-assisted HCC coding workflows
- Background in health plan, Medicare Advantage, accountable care, or value-based care risk adjustment operations
- Familiarity with AI tools and comfort evaluating AI-generated risk adjustment and HCC coding content
- Experience presenting risk adjustment performance, coding quality findings, or documentation improvement opportunities to actuarial, compliance, clinical, or executive teams
- Strong ability to identify risk score integrity issues, documentation improvement opportunities, and coding compliance risks
Responsibilities
- Review risk adjustment coding workflows across Medicare Advantage, Medicaid managed care, and ACA risk adjustment programs
- Evaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy, documentation support, and regulatory compliance
- Review medical records to determine whether HCC-eligible conditions are fully and accurately supported by clinical documentation
- Identify coding inaccuracies, unsupported diagnoses, documentation gaps, missed HCC opportunities, and compliance concerns
- Assess retrospective and prospective chart review outputs for completeness, accuracy, and risk score relevance
- Evaluate outputs related to CMS-HCC, RxHCC, and ACA HHS-HCC methodologies
- Support review of RADV audit preparation, audit response workflows, and risk adjustment data validation requirements
- Review risk adjustment KPIs such as HCC capture rates, risk score accuracy, chart retrieval rates, and coding quality indicators
- Annotate AI-generated coding and risk adjustment outputs and provide structured feedback to support quality improvement
- Explain review decisions clearly, consistently, and with strong coding and compliance judgment
- Evaluate outputs for alignment with CMS risk adjustment guidance, ICD-10-CM coding standards, Official Coding Guidelines, RAPS, EDGE submissions, and applicable compliance expectations
- Follow detailed task instructions, quality criteria, and project-specific review guidelines accurately
Benefits
- Competitive hourly compensation
- Flexible scheduling
- Weekly payments
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What This Job Offers
Job Type
Part-time
Career Level
Senior
Education Level
No Education Listed
