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Medicare Risk Adjustment Coding Educator Jobs in New York

Essen Healthcare

Be Seen First

Director of Coding Compliance

Bronx, NY · On-site

$85K - $110K/yr

Strong knowledge of CMS regulations, Medicare Advantage, NYS Medicaid, HEDIS, and risk adjustment ... Provider Education * Cross-Functional Collaboration * Strategic Problem Solving * Data Analysis ...

Stanford Health Care

Physician Educator III

Newark, NJ · On-site

$44.13 - $57.36/hr

Risk Adjustment Education * Educates and guides healthcare providers and staff on accurate clinical documentation and coding practices, particularly concerning Hierarchical Condition Categories (HCCs ...

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Medicare Risk Adjustment Coding Educator information

What is the difference between Medicare Risk Adjustment Coding Educator vs Medicare Coding Specialist?

AspectMedicare Risk Adjustment Coding EducatorMedicare Coding Specialist
CertificationsAHIMA or AAPC certifications, risk adjustment trainingAHIMA or AAPC coding certifications, Medicare-specific coding credentials
Work EnvironmentTraining sessions, educational settings, healthcare organizationsClinical coding departments, healthcare facilities, insurance companies
Employer & Industry UsageHospitals, health plans, educational institutionsHospitals, clinics, insurance providers

The Medicare Risk Adjustment Coding Educator focuses on training healthcare professionals in risk adjustment coding principles, while the Medicare Coding Specialist applies coding directly to patient records and claims. Both roles require coding certifications and knowledge of Medicare guidelines, but educators emphasize teaching and compliance, whereas specialists focus on accurate coding for reimbursement.

What are the key skills and qualifications needed to thrive as a Medicare Risk Adjustment Coding Educator?

To thrive as a Medicare Risk Adjustment Coding Educator, you need in-depth knowledge of ICD-10-CM coding, HCC risk adjustment models, and healthcare compliance, typically backed by certifications such as CPC, CRC, or CCS. Familiarity with coding software, electronic health record (EHR) systems, and auditing tools is essential for training and quality assurance. Excellent communication, presentation, and interpersonal skills help engage learners and clarify complex regulations. These skills ensure accurate coding practices, optimize revenue integrity, and support compliance in Medicare risk adjustment programs.

What are some common challenges faced by Medicare Risk Adjustment Coding Educators in ensuring coding accuracy across teams?

Medicare Risk Adjustment Coding Educators often encounter challenges such as varying levels of coding proficiency among staff, frequent updates to CMS guidelines, and the need to keep teams consistently informed about compliance changes. Educators must develop effective training methods tailored to different learning styles and regularly audit coding work to identify and address gaps. Collaboration with clinical staff and coders is key to maintaining high accuracy, and ongoing education is essential to support both new and experienced team members.

What is a Medicare Risk Adjustment Coding Educator?

A Medicare Risk Adjustment Coding Educator is a healthcare professional responsible for training and educating medical coders, providers, and staff on risk adjustment coding guidelines as they pertain to Medicare. Their primary role is to ensure accurate and compliant coding of diagnoses, which affects risk scores and reimbursement under Medicare Advantage plans. They stay current with CMS policies and regulations, develop educational materials, and conduct audits to identify areas for improvement. By fostering correct coding practices, they help healthcare organizations optimize revenue and maintain compliance.
What are popular job titles related to Medicare Risk Adjustment Coding Educator jobs in New York? For Medicare Risk Adjustment Coding Educator jobs in New York, the most frequently searched job titles are:
What job categories do people searching Medicare Risk Adjustment Coding Educator jobs in New York look for? The top searched job categories for Medicare Risk Adjustment Coding Educator jobs in New York are:
What cities in New York are hiring for Medicare Risk Adjustment Coding Educator jobs? Cities in New York with the most Medicare Risk Adjustment Coding Educator job openings:
Medicare Risk Adjustment Coding Educator jobs near you
Infographic showing various Medicare Risk Adjustment Coding Educator job openings in New York as of August 2026, with employment types broken down into 94% Full Time, and 6% Part Time. Highlights an 67% In-person, and 33% Remote job distribution.

Director of Coding Compliance

Essen Medical Associates

Bronx, NY • On-site

Other

Re-posted 22 days ago

Essen Health Care rating

4.6

Company rating: 4.6 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

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

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