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.
Key Responsibilities
Professionals in this role may contribute to:
Risk Adjustment & HCC Coding Review
- 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
Chart Review, RADV & Risk Score Evaluation
- 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
Structured Coding Feedback & Quality Control
- 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
Ideal Profile
Strong candidates may have:
- 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
Educational Background
- 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
- Experience in health plans, Medicare Advantage organizations, Medicaid managed care organizations, provider groups, 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, healthcare administration, nursing, clinical documentation, or a related healthcare field may be relevant depending on project scope
Nice to Have
- 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
Why This Opportunity
- Apply HCC coding and risk adjustment expertise to structured remote healthcare project work
- Contribute to high-quality AI-assisted risk adjustment coding and documentation review
- Use coding leadership, audit preparation experience, and compliance judgment in a focused review environment
- Work on flexible assignments aligned with Medicare Advantage, managed care, ACA risk adjustment, and value-based care expertise
- Remote structure with competitive hourly compensation
Contract Details
- Independent contractor role
- Fully remote with flexible scheduling
- United States-based professionals are required for this opportunity
- Part-time project-based commitment depending on availability, onboarding status, and project needs
- Competitive rates of up to $85 per hour depending on risk adjustment experience, HCC coding expertise, leadership background, and project scope
- Weekly payments via Stripe or Wise
- Projects may be extended, shortened, or adjusted depending on scope and performance
- Work will not involve access to confidential or proprietary information from any employer, client, or institution
About the Platform
This opportunity is available through 24-MAG LLC. We connect experienced professionals with remote consulting opportunities across technical, evaluation, and project-based workstreams.
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