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Medicare Risk Adjustment Coding Educator Jobs in New York

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 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 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 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.

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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.

ACO Risk Coding Specialist (Hybrid)

Essen Medical Associates

Bronx, NY • On-site

$27/hr

Full-time

Re-posted 24 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

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 CMSHCC risk adjustment model (required for accurate coding and compliance)
- Solid understanding of ICD10CM coding guidelines
- Ability to accurately identify and code chronic conditions requiring annual recapture
- Experience reviewing facetoface 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 problemsolving skills, especially in Excel
- Ability to research and resolve coding discrepancies independently
- Effective written and verbal communication with clinical and nonclinical 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.

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