Remote Risk Adjustment Coder Jobs in Jersey City, NJ

Specialised Part-Time Consulting OpportunityWe 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 ResponsibilitiesProfessionals in this role may contribute to:Risk Adjustment & HCC Coding ReviewChart Review, RADV & Risk Score EvaluationStructured Coding Feedback & Quality ControlRisk Adjustment & HCC Coding ReviewReview risk adjustment coding workflows across Medicare Advantage, Medicaid managed care, and ACA risk adjustment programsEvaluate AI-generated HCC coding assignments and risk adjustment recommendations for clinical accuracy, documentation support, and regulatory complianceReview medical records to determine whether HCC-eligible conditions are fully and accurately supported by clinical documentationIdentify coding inaccuracies, unsupported diagnoses, documentation gaps, missed HCC opportunities, and compliance concernsChart Review, RADV & Risk Score EvaluationAssess retrospective and prospective chart review outputs for completeness, accuracy, and risk score relevanceEvaluate outputs related to CMS-HCC, RxHCC, and ACA HHS-HCC methodologiesSupport review of RADV audit preparation, audit response workflows, and risk adjustment data validation requirementsReview risk adjustment KPIs such as HCC capture rates, risk score accuracy, chart retrieval rates, and coding quality indicatorsStructured Coding Feedback & Quality ControlAnnotate AI-generated coding and risk adjustment outputs and provide structured feedback to support quality improvementExplain review decisions clearly, consistently, and with strong coding and compliance judgmentEvaluate outputs for alignment with CMS risk adjustment guidance, ICD-10-CM coding standards, Official Coding Guidelines, RAPS, EDGE submissions, and applicable compliance expectationsFollow detailed task instructions, quality criteria, and project-specific review guidelines accuratelyIdeal ProfileStrong candidates may have:5+ years of experience in risk adjustment coding, HCC coding, Medicare Advantage coding operations, or related healthcare coding workflowsAt least 2 years of leadership experience in risk adjustment, HCC coding, coding quality, chart review, or coding operationsDeep expertise in CMS-HCC, RxHCC, and/or ACA HHS-HCC risk adjustment methodologiesStrong knowledge of ICD-10-CM coding guidelines as applied to risk adjustment and HCC documentationExperience with RADV audit preparation, CMS compliance requirements, chart retrieval workflows, and risk adjustment quality reviewFamiliarity with RAPS and EDGE submission processesExceptional written and verbal English communication skillsHigh attention to detail and ability to identify coding inaccuracies, unsupported diagnoses, and documentation gaps in AI-generated outputsEducational BackgroundProfessional 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 relevantExperience in health plans, Medicare Advantage organizations, Medicaid managed care organizations, provider groups, value-based care organizations, or coding vendor environments may be especially valuablePractical experience with chart review systems, coding platforms, risk adjustment analytics tools, EHR documentation, and audit workflows may support project fitFormal 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 scopeNice to HaveCRC, CCS, CPC, RHIA, or similar coding or health information credentialExperience with risk adjustment analytics platforms, chart retrieval systems, coding quality tools, or AI-assisted HCC coding workflowsBackground in health plan, Medicare Advantage, accountable care, or value-based care risk adjustment operationsFamiliarity with AI tools and comfort evaluating AI-generated risk adjustment and HCC coding contentExperience presenting risk adjustment performance, coding quality findings, or documentation improvement opportunities to actuarial, compliance, clinical, or executive teamsStrong ability to identify risk score integrity issues, documentation improvement opportunities, and coding compliance risksWhy This OpportunityApply HCC coding and risk adjustment expertise to structured remote healthcare project workContribute to high-quality AI-assisted risk adjustment coding and documentation reviewUse coding leadership, audit preparation experience, and compliance judgment in a focused review environmentWork on flexible assignments aligned with Medicare Advantage, managed care, ACA risk adjustment, and value-based care expertiseRemote structure with competitive hourly compensationContract DetailsIndependent contractor roleFully remote with flexible schedulingUnited States-based professionals are required for this opportunityPart-time project-based commitment depending on availability, onboarding status, and project needsCompetitive rates of up to $85 per hour depending on risk adjustment experience, HCC coding expertise, leadership background, and project scopeWeekly payments via Stripe or WiseProjects may be extended, shortened, or adjusted depending on scope and performanceWork will not involve access to confidential or proprietary information from any employer, client, or institutionAbout the PlatformThis opportunity is available through 24-MAG LLC. 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