ACO Risk Coding Specialist (Hybrid)

Essen Healthcare; Northern, New York (KY, NY); Hybrid; USD 33,000 - 47,000; Full time

Job summary

Essen Health care seeks a risk coding specialist to implement coding guidelines and document disease burden. You will become proficient in HCC-based risk adjustment, review charts to identify suspect conditions, and design workflows to ensure providers are informed for thorough assessment and documentation.

Responsibilities include overseeing offshore coding activities, educating providers on documentation standards, and driving improvements to maintain coding integrity across a multi-location

Qualifications

• CMS-HCC risk adjustment knowledge required for accurate coding and compliance.
• Solid understanding of ICD-10-CM coding guidelines.
• Ability to identify and code chronic conditions requiring recapture.

Responsibilities

• Learn risk coding concepts and criteria for surfacing, proving, and documenting conditions.
• Oversee offshore team conducting risk coding activities.
• Conduct chart reviews to identify suspect conditions and highlight improperly coded notes.
• Design workflows to notify providers of suspect conditions.
• Ensure labs and imaging relevant to risk adjustment are reviewed by providers.
• Educate providers on proper documentation and coding guidelines.
• Suggest improvements to workflows to maximize coding integrity.

Skills

CMS-HCC

ICD-10-CM

Chart reviews

Offshore mgmt

KPIs

Excel

Documentation accuracy

Communication

Education delivery

Education

High School Diploma

International Medical Graduate

CRC

CPC or RHIT/RHIA

Job description

Overview

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.

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
• 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.