HiLabs
Website:
hilabs.com
Job details:
HiLabs Inc. is on a mission to eliminate the $3.1 trillion cost of bad data in the US healthcare system. We combine explainable AI, healthcare-specific business ontologies, and big data to dramatically improve data quality for our customers.
Our core platform, MCheck™, has analyzed 15+ billion healthcare records, covering over one-third of the US insured population.
Headquartered in the Washington DC area, HiLabs has a rapidly growing R&D center in India and a team of world-class technologists, data scientists, and healthcare experts from institutions like Harvard, Yale, Duke, Georgia Tech, and IITs.
Role Summary
We are looking for an experienced Senior Risk Adjustment Coder and CDI Specialist for a 2 to 3 month contract engagement, fully remote.
This role requires a deep understanding of HCC validation, MEAT criteria, and audit-ready coding practices, working closely with clinical and analytics teams to ensure accurate and defensible risk adjustment outcomes. Immediate joiners are preferred.
Key Responsibilities
Own end-to-end chart review and HCC validation across prospective and retrospective workflows
Ensure all diagnoses meet MEAT criteria and are clinically supported
Review complex cases for coding accuracy and audit defensibility
Collaborate with CDI and clinical teams to improve documentation quality
Ensure compliance with CMS guidelines and ICD-10-CM standards
Support RADV audit readiness and audit-related queries
Identify documentation gaps and provide actionable insights
Contribute to improving risk adjustment accuracy and RAF score integrity
Maintain high productivity and quality standards
Stay updated with CMS-HCC model changes, including V28
Desired Profile
- Bachelor’s degree in Life Sciences, Pharmacy, Nursing, or related field
- 5–10+ years of experience in Risk Adjustment, HCC coding, or CDI
- Certification in CRC or CPC is mandatory
- Strong experience with CMS-HCC coding and Medicare Advantage
- Hands-on experience in retrospective and prospective chart reviews
- Strong understanding of MEAT criteria and documentation standards
- Exposure to RADV audits and audit-ready coding practices
- Ability to interpret clinical documentation and translate into accurate coding
- Strong analytical and communication skills
- Clinical background such as RN preferred
Why Join HiLabs
- Opportunity to work on high-impact, short-term risk adjustment projects
- Fully remote flexibility for the duration of the contract
- Exposure to cutting-edge AI, ML, and big data problems in healthcare
- Collaborative environment with strong domain and technical experts
Equal Opportunity Employer
HiLabs is an equal opportunity employer and is committed to building a diverse and inclusive workplace. If this role aligns with your experience and career goals, we encourage you to apply.
Click on Apply to know more.
