Risk Adjustment and HCC Coding Reviewer (Lead)

About OpenTrain

OpenTrain is the #1 platform for finding and building careers in AI training and data labeling. We help people start and grow careers teaching AI by bringing specialized projects and tools together under one account.

OpenTrain AI is the hiring and contracting organization for this role. Creating an OpenTrain account is free and lets you apply, build a portfolio, and track work across AI-training projects in one place.

Why AI Training Work Matters

AI training (also called data labeling or human feedback work) is the human side of building modern AI. Reviewers like you shape model behavior by verifying outputs, annotating examples, and giving structured feedback that directly improves AI systems.

This project sits at the intersection of clinical coding and machine learning: your reviews will improve AI-assisted HCC coding accuracy used for risk adjustment and regulatory reporting.

• Flexible, remote work that fits around other commitments.
• Contribute directly to safer, more accurate healthcare AI tools.

The Role

You will lead reviews of AI-generated Hierarchical Condition Category (HCC) coding recommendations and compare them to clinical documentation to confirm coding accuracy and regulatory compliance.

Work includes retrospective and prospective chart reviews, monitoring capture and risk score performance, supporting RADV audit prep, and annotating AI outputs with structured feedback to create high-quality training data.

• Review AI-generated HCC coding for clinical accuracy and regulatory compliance.
• Examine medical records to confirm HCC-eligible conditions are supported by documentation.
• Lead retrospective and prospective chart reviews to optimize risk scores.
• Support RADV audit preparation and response workflows.
• Monitor HCC capture rates, risk score accuracy, and chart retrieval performance.
• Collaborate with clinical, coding, and compliance stakeholders to improve documentation.
• Apply CMS risk adjustment guidance including RAPS and EDGE submission requirements.
• Annotate AI outputs with structured feedback for training datasets (document data type; label types include evaluation_rating and text_generation).

Requirements

This is an expert-level role that requires deep, hands-on experience in risk adjustment and HCC coding plus leadership experience. All required qualifications below are essential.

• 5+ years in risk adjustment coding, HCC coding, or Medicare Advantage coding operations.
• At least 2 years in a leadership role managing coding or risk adjustment work.
• Deep knowledge of CMS-HCC, RxHCC, and/or ACA HHS-HCC methodologies.
• Strong understanding and application of ICD-10-CM coding guidelines for risk adjustment.
• Experience with RADV audit preparation and CMS compliance requirements.
• Familiarity with RAPS and EDGE submission processes.
• Clear written and verbal English communication skills and strong attention to detail.
• Experience evaluating HCC coding accuracy against medical documentation.

Helpful Background

These additional credentials and experiences are valuable but not strictly required. They will help you hit the ground running and expand the types of projects you can lead.

• Professional credentials such as CRC, CCS, CPC, or RHIA.
• Experience with risk adjustment analytics platforms, chart retrieval systems, or health plan operations.
• Background working within Medicare Advantage, Medicaid managed care, or value-based care organizations.
• Familiarity with AI-assisted HCC coding tools and annotating model outputs.
• Experience presenting risk adjustment performance to actuarial or executive teams.

Logistics, Pay, and Schedule

This is a contract, part-time role for US-based contributors only. You must be able to work a minimum of 20 hours per week and deliver expert-quality chart reviews and annotations.

Pay is USD, hourly, at a fixed rate of $110 per hour. Work centers on document review tasks and structured feedback labeling to improve AI training data.

• Contract type: Contractor, Part-time.
• Time requirement: 20+ hours/week.
• Location: United States only (remote).
• Language: English required.
• Pay: $110 USD per hour (PAY_PER_HOUR).
• Data type: Document review; Labeling types: evaluation_rating, text_generation.

How It Works and Who Should Apply

Apply through your OpenTrain account—create one for free if you don’t already have it. Build a profile that highlights your coding credentials, leadership experience, and risk adjustment work.

This role is ideal for experienced HCC/risk adjustment leads who want flexible, remote contract work that directly improves AI tools used across Medicare Advantage, Medicaid managed care, and ACA risk adjustment.

• Prepare to submit examples of prior coding work or describe audit and leadership experience during the application.
• Once selected, you'll review AI outputs, complete structured annotations, and collaborate with the OpenTrain team on quality and compliance goals.