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Medicare Risk Adjustment Coding Educator Jobs in New York

EmblemHealth

Staff Actuary - Medicare

New York, NY · On-site

$77K - $149K/yr

Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs ... and/or education required * 4+ years health insurance actuarial experience, preferably in the ...

EmblemHealth

Staff Actuary - Medicare

New York, NY · On-site +1

Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs ... and/or education required * 4+ years health insurance actuarial experience, preferably in the ...

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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.

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.

Manager, Risk Adjustment & Clinical Operations

Daymark Health

New York, NY

$120K - $150K/yr

Full-time

Posted yesterday

New

Job description

Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. Daymark's comprehensive, personalized cancer care platform empowers patients with dedicated care navigation, symptom-focused support, behavioral health care, and social resources. Combined with evidence-based health interventions and a hybrid in-person + virtual care model, Daymark is improving the overall cancer experience for patients, providers, and health plans – and setting a new standard in cancer care. 

Daymark's groundbreaking approach is led by CEO Dr. Justin Bekelman, a pioneer in transforming cancer care, alongside some of the nation's foremost leaders in oncology and value-based care. Daymark Health is backed by Maverick Ventures, Yosemite, Oncology Ventures, Healthier Capital, Blue Venture Fund, and Healthcare Foundry.

Be cautious of recruitment fraud, and always confirm that communications are coming from an official Daymark Health email.

ABOUT THE ROLE

We are seeking a highly capable operator to lead Risk Adjustment Operations at Daymark while also serving as a core member of the Clinical Operations team. This role sits at the intersection of Clinical Operations, Finance, Product, and Data, and is responsible for ensuring we accurately capture patient complexity in a way that reflects the true clinical needs of our population.

You will take the lead in building and scaling our risk adjustment approach, from identifying opportunities to embedding workflows into care delivery to driving measurable performance improvement. Beyond risk adjustment, this role is part of the broader Clinical Operations team and will flex into other high-priority operational initiatives, including market launches, care delivery workflows, and enrollment operations.

This role is ideal for someone who enjoys owning a critical domain while also working across a wide range of operational problems in a fast-moving, early-stage environment.

WHAT YOU'LL DO

Build and Scale Daymark's Risk Adjustment Operations
  • Define and operationalize our approach to risk capture, aligned with our care model and payer contracts
  • Identify opportunities for improving documentation (e.g., suspects and refreshables)
  • Design and implement workflows that integrate risk adjustment into care delivery and partner with Care Teams to ensure those workflows are usable, adopted, and effective
  • Partner with Product and Data to ensure workflows are reflected in tools and supported by accurate, timely data
  • Evaluate and manage vendors supporting chart prep, suspecting, and coding workflows
  • Establish performance tracking, reporting, and review cadences and Identify gaps in performance to drive targeted improvements

Broader Clinical Operations Priorities and Execution.

  • Improve care delivery workflows, enrollment operations, and cross-team coordination
  • Diagnose operational friction and implement solutions that improve reliability and efficiency
  • Partner with cross-functional teams to translate operational needs into workflows, tools, and processes
  • Support operational readiness for new markets and service lines
  • Step into high-priority operational initiatives as they emerge

Operational Infrastructure & Scaling

  • Translate strategic priorities into operational workplans
  • Ensure KPIs have clear ownership and follow-through
  • Support operational review cadence and performance visibility
  • Identify execution gaps and help drive resolution

WHAT WE ARE LOOKING FOR

Experience

  • Experience in risk adjustment, population health, or value-based care operations
  • Strong understanding of HCC coding, suspecting, and chart review workflows
  • Experience working with clinicians and embedding workflows into care delivery
  • Experience partnering with Product, Data, and Analytics teams
  • Startup or high-growth experience is a plus

Qualities

  • You are both strategic and highly execution-oriented
  • You can translate complex concepts into practical workflows
  • You are comfortable working across clinical, operational, and technical teams
  • You thrive in ambiguity and enjoy building from scratch
  • You are excited to own a domain while also contributing more broadly across the business

Additional Information

The expected compensation for this role is $120,000 to $150,000 annually, depending on location & experience.

This role is based in XX but will operate on either Central or Eastern time business hours.