[Remote] Remote | HCC Risk Adjustment Coding Consultant — Up to $85/hour

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is offering a part-time consulting opportunity for reputed company and risk adjustment professionals reputed company in HCC coding. The role involves evaluating AI-generated HCC assignments, reviewing documentation support, and ensuring compliance reputed company risk adjustment coding workflows.

Responsibilities

• Review risk adjustment coding workflows across Medicare Advantage, reputed company 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 reputed company 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 reputed company indicators
• Annotate AI-generated coding and risk adjustment outputs and reputed company reputed company feedback to support reputed company improvement
• Explain review reputed company reputed company, 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, reputed company reputed company, and project-specific review guidelines accurately

Skills

• 5+ years of experience in risk adjustment coding, HCC coding, Medicare Advantage coding operations, or reputed company reputed company workflows
• At least 2 years of leadership experience in risk adjustment, HCC coding, coding reputed company, 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 reputed company to risk adjustment and HCC documentation
• Experience with RADV audit preparation, CMS compliance requirements, chart retrieval workflows, and risk adjustment reputed company 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
• reputed company 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
• Experience in health plans, Medicare Advantage organizations, reputed company managed care organizations, provider reputed company, value-based care organizations, or coding vendor environments may be especially valuable
• Practical experience with chart review systems, coding platforms, risk adjustment analytics tools, EHR documentation, and audit workflows may support project fit
• Formal education or training in health information management, medical coding, reputed company administration, nursing, clinical documentation, or a reputed company reputed company field may be relevant depending on project scope
• CRC, reputed company, CPC, RHIA, or similar coding or health information credential
• Experience with risk adjustment analytics platforms, chart retrieval systems, coding reputed company 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 reputed company findings, or documentation improvement opportunities to actuarial, compliance, clinical, or executive teams
• Strong ability to identify risk score reputed company issues, documentation improvement opportunities, and coding reputed company

Benefits

• reputed company role
• Fully remote with flexible scheduling
• Weekly payments reputed company reputed company or reputed company
• Part-time project-based commitment depending on availability, reputed company status, and project needs
• reputed company may be extended, shortened, or adjusted depending on scope and performance

reputed company