ACO Risk Coding Specialist (Hybrid)

Essen Health Care; New York (NY); On-site; USD 71,635,000 - 82,656,000; Full time

Benefits offered by this job

Bonuses

OT available

Full-time employment

Job summary

Essen Health Care is seeking a risk coding specialist to implement CMS-HCC guidelines and ensure accurate documentation of disease burden across 50+ locations in New York. The role involves reviewing charts, identifying suspect conditions, and designing workflows to alert providers for thorough documentation.

Ideal candidates will have CRC or CPC/CCS/RHIT/RHIA credentials, familiarity with ICD-10-CM, and experience with coaching providers and coordinating offshore teams to improve coding quality.

Qualifications

• Strong working knowledge of CMS-HCC risk adjustment and ICD-10-CM guidelines.
• Ability to accurately identify and code chronic conditions requiring annual recapture.
• Experience with chart reviews and documentation improvement initiatives.

Responsibilities

• Oversee an offshore team in conducting risk coding activities.
• Conduct chart reviews to identify suspect conditions and highlight inadequately coded progress notes.
• Design workflows to notify doctors of suspect conditions and ensure relevant results are reviewed.
• Educate providers on proper documentation and coding guidelines.
• Suggest improvements to team workflows to maximize coding integrity.

Skills

CMS-HCC risk adjustment

ICD-10-CM coding

Chronic condition coding

Chart reviews

Provider education

Documentation improvement

Excel

KPIs reporting

Offshore team coordination

Education

High School Diploma or equivalent

International Medical Graduate

CRC

CPC/CCS/RHIT/RHIA

Job description

Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to some of the state’s most vulnerable and underserved residents.

Founded in 1999, we’ve grown from a single primary care office into a network of 50+ locations offering urgent care, primary care and specialty services, from women’s health to endocrinology and psychiatry. We also provide nursing home support, care management, and in-home care through our Essen House Calls program. Guided by a Population Health model, our team of 500+ providers deliver care in-person, at home, or via telehealth, ensuring patients get the support they need when and where they need it.

We’re looking for talented, motivated individuals to join our growing team. Whether you’re a medical provider, administrator, or operations professional, there’s a career here for you. Join us in making a real difference in the health of our community.

The risk coding specialist will help providers to implement coding guidelines and properly document the disease burden of their patients. They will become experts in HCC-based risk adjustment (prior experience preferred, but not necessary), they will conduct medical chart reviews to identify suspect conditions, and they will design and manage workflows to ensure that providers are made aware of suspect conditions, so that they can evaluate the patient thoroughly and correctly document the patient’s risk factors.

• Learn the details risk coding and adjustment. What are the categories of diseases that matter, and what are the criteria required for (a) surfacing, (b) proving, and (c) documenting a particular condition.
• Oversee an offshore team in conducting risk coding activities
• Conduct chart reviews to identify suspect conditions and highlight inadequately coded progress notes.
• Design workflows to notify doctors of suspect conditions.
• Ensure incoming labs and diagnostic imaging results relevant to risk adjustment are brought to provider’s attention.
• Education providers on proper documentation and coding guidelines.
• Suggest improvements to team workflows to ensure maximum coding integrity.

Qualifications

• Strong working knowledge of CMS‑HCC risk adjustment model (required for accurate coding and compliance)
• Solid understanding of ICD‑10‑CM coding guidelines
• Ability to accurately identify and code chronic conditions requiring annual recapture
• Experience reviewing face‑to‑face encounters and validating provider documentation
• Skilled in retrospective and/or prospective chart reviews
• Experience with provider education or documentation improvement initiatives

Knowledge, Skills, & Abilities

• Deep understanding of chronic disease processes (e.g., CHF, CKD, COPD, diabetes with complications)
• Familiarity with hierarchical logic and exclusion rules in HCC coding
• Strong analytical, organizational, and problem‑solving skills, especially in Excel
• Ability to research and resolve coding discrepancies independently
• Effective written and verbal communication with clinical and non‑clinical staff
• Team-based orientation with ability to manage and report out KPIs
• Cultural sensitivity and ability to work with diverse team members, both US‑based and offshore, and with medical providers
• Consistent ability to meet productivity and quality benchmarks

Education

• High School Diploma or equivalent (required)
• International Medical Graduate (preferred)
• Certified Risk Adjustment Coder (CRC)
• Certified Professional Coder (CPC) or CCS / RHIT / RHIA (AAPC or AHIMA)

Compensation & Benefits

• Pay $27/hr base, some OT available, performance‑based bonuses
• Job Type Full‑time

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.