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Director Of Coding Compliance

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

Position Title: Director Of Coding Compliance

Position Summary: The Director Of Coding Compliance is responsible for leading coding compliance and audit activities related to health plan operations, risk adjustment, payer audits and regulatory requirements. This role ensures accurate medical coding, documentation integrity, and adherence to federal, state, and payer-specific guidelines. The ideal candidate will possess advanced CPC coding expertise, strong analytical skills, and extensive experience supporting compliance initiatives within a managed care or health plan environment.

Responsibilities

Key Responsibilities

• Conduct complex coding audits and documentation reviews for accuracy, completeness, and regulatory compliance.
• Review ICD-10-CM, CPT, HCPCS, and risk adjustment coding to ensure alignment with CMS and payer guidelines.
• Identify coding trends, compliance risks, and opportunities for operational improvement.
• Partner with Compliance, SIU, Clinical Operations, Provider Education, and RCM teams to support organizational initiatives.
• Develop and deliver provider and staff education related to coding accuracy and compliance standards.
• Monitor regulatory changes and communicate impacts to leadership and operational teams.
• Assist with internal and external audit preparation, corrective action plans, and regulatory responses.
• Support oversight activities related to FWA (Fraud, Waste, and Abuse) prevention and documentation integrity.
• Analyze audit findings and prepare detailed reports, dashboards, and executive summaries.
• Serve as a subject matter expert for coding compliance and regulatory requirements.

Qualifications

Required Qualifications

• Certified Professional Coder (CPC) certification required.
• Minimum 7–10 years of medical coding and compliance auditing experience.
• Minimum 5 years of experience within a health plan, managed care organization, or payer environment.
• Strong knowledge of CMS regulations, Medicare Advantage, NYS Medicaid, HEDIS, and risk adjustment methodologies.
• Extensive experience with ICD-10-CM, CPT, and HCPCS coding systems.
• Knowledge of healthcare compliance standards and regulatory requirements.
• Experience conducting coding audits and developing corrective action plans.
• Strong analytical, communication, and leadership skills.
• Proficiency with coding and audit software applications and Microsoft Office Suite.

Preferred Qualifications

• CRC, CPMA, CCS, or other advanced coding/audit certification preferred.
• Experience supporting delegated vendor oversight and regulatory audits.
• Knowledge of NCQA standards and healthcare quality programs.
• Bachelor's degree in Health Information Management, Healthcare Administration, Nursing, or related field preferred.

Core Competencies

• Regulatory Compliance
• Risk Assessment
• Medical Coding Expertise
• Audit & Monitoring
• Provider Education
• Cross-Functional Collaboration
• Strategic Problem Solving
• Data Analysis & Reporting

Work Environment

• Onsite - Bronx, New York Office Monday - Friday

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