ACO Risk Coding Specialist (Hybrid)

Essen Medical Associates; New York (NY); On-site; USD 30,686 - 43,704; Full time

Job summary

Essen Medical Associates in New York is seeking a dedicated risk coding specialist to support providers in implementing coding guidelines and enhancing documentation of patient conditions. The position offers full-time engagement in a crucial role that supports healthcare quality for vulnerable populations.

The ideal candidate will possess a strong knowledge of HCC-based risk adjustments, and engage in chart reviews to highlight coding opportunities, thereby ensuring accurate patient documentation.

Qualifications

• Required experience with CMS-HCC risk adjustment coding.
• Familiarity with chronic disease processes such as CHF and diabetes.
• Proven skills in managing coding discrepancies.

Responsibilities

• Learn the details risk coding and adjustment.
• Oversee an offshore team in conducting risk coding activities.
• Conduct chart reviews to identify suspect conditions.

Skills

Strong working knowledge of CMS‑HCC risk adjustment model

Solid understanding of ICD‑10‑CM coding guidelines

Ability to accurately identify and code chronic conditions

Experience reviewing face‑to‑face encounters

Skilled in retrospective and/or prospective chart reviews

Experience with provider education

Education

High School Diploma or equivalent

International Medical Graduate

Certified Risk Adjustment Coder (CRC)

Certified Professional Coder (CPC) or CCS / RHIT / RHIA

Tools

Excel

Job description

Overview

About Intention Healthcare, An Essen Health Care Company

As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and underserved residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 25‑year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system.

Intention Healthcare is a division of Essen providing physician house calls, and it is the largest provider of house calls in New York. We provide compassionate medical care and care management services to ensure that our over 22,000 disabled and otherwise homebound seniors can live safely, comfortably, and with dignity in their homes.

Job Summary

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.

Responsibilities

• 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

Equal Opportunity Employer

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.