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Remote Hcc Risk Adjustment Coder Jobs in Bronx, NY

EmblemHealth

Lead Audit Specialist - Remote

New York, NY · On-site +1

$77K - $149K/yr

... risk adjustment. Manage vendor relationships and contracts to ensure audit vendors follow best ... HCC validation, Demographic and Enrollment (D&E) validation and Pharmacy Claims ("RXC") validation ...

Advanced Medical Management

Medical Assistant

New York, NY · Remote

$21 - $23/hr

... risk adjustment. Pre-Visit Planning • Prepare and maintain Pre-Visit Checklists for upcoming ... HCC) requiring MEAT documentation • Previous hospitalizations, ER visits, or consults • Ensure ...

EmblemHealth

Staff Actuary

New York, NY · Remote

REMOTE Summary of Position * Provide the analytical resources necessary for the development of ... Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs ...

EmblemHealth

Staff Actuary - Medicare

New York, NY · On-site +1

REMOTE Summary: * Provide the analytical resources necessary for the development of overall pricing ... Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs ...

Catholic Health

CDI Educator

Melville, NY · On-site +1

$115K - $165K/yr

This will be a Hybrid on-site/remote position. Job Responsibilities * Lead and maintain a formal ... Knowledge of software regarding risk adjustment Desired Attributes * Passion for teaching and ...

Catholic Health

CDI Educator

Melville, NY · On-site +1

$115K - $165K/yr

This will be a Hybrid on-site/remote position. Job Responsibilities * Lead and maintain a formal ... Knowledge of software regarding risk adjustment Desired Attributes * Passion for teaching and ...

Catholic Health

CDI Educator

Melville, NY · On-site +1

$115K - $165K/yr

This will be a Hybrid on-site/remote position. Job Responsibilities * Lead and maintain a formal ... Knowledge of software regarding risk adjustment Desired Attributes * Passion for teaching and ...

Catholic Health

CDI Second Level Reviewer

Melville, NY · On-site +1

$145K - $180K/yr

Identify and act on missed documentation opportunities impacting severity, risk adjustment, and ... Collaborate with coding and CDI Physician Advisors, as needed, on cases with potential ...

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All JobsRemote Hcc Risk Adjustment Coder JobsRemote Hcc Risk Adjustment Coder Jobs in Bronx, NY

Remote Hcc Risk Adjustment Coder information

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$16

$23

$35

How much do remote hcc risk adjustment coder jobs pay per hour?

As of Jun 24, 2026, the average hourly pay for remote hcc risk adjustment coder in Bronx, NY is $23.36, according to ZipRecruiter salary data. Most workers in this role earn between $18.80 and $25.05 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote HCC Risk Adjustment Coder, and why are they important?

To thrive as a Remote HCC Risk Adjustment Coder, you need a solid understanding of ICD-10-CM coding guidelines, risk adjustment models, and extensive experience in medical record review, typically supported by a relevant coding certification such as CPC or CRC. Proficiency with electronic health record (EHR) systems, coding software, and risk adjustment platforms is essential. Exceptional attention to detail, analytical thinking, and strong communication skills help coders excel in remote settings and ensure coding accuracy. These skills and qualifications are vital for optimizing risk scores, ensuring compliance, and supporting accurate reimbursement in healthcare organizations.

What is a Remote HCC Risk Adjustment Coder?

A Remote HCC Risk Adjustment Coder is a medical coding professional who works from home or another remote location, reviewing patient medical records to assign Hierarchical Condition Category (HCC) codes. These codes are used by healthcare organizations to accurately reflect the severity of patient illnesses for risk adjustment and reimbursement purposes, especially in Medicare Advantage programs. The coder analyzes clinical documentation to ensure that diagnoses are coded correctly and in compliance with regulatory guidelines. Their work is essential for ensuring healthcare providers receive appropriate compensation and for maintaining accurate patient risk profiles.

What are some common challenges faced by remote HCC Risk Adjustment Coders and how can they be managed?

Remote HCC Risk Adjustment Coders often encounter challenges such as interpreting incomplete or ambiguous medical documentation, staying updated with evolving coding guidelines, and managing communication across dispersed teams. To address these challenges, it's important to proactively seek clarification from providers, participate in ongoing training, and utilize collaboration tools to stay connected with peers and supervisors. Establishing a structured daily workflow and leveraging available resources can also help maintain coding accuracy and productivity in a remote setting.
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Remote Hcc Risk Adjustment Coder jobs near you
Compliance Lead - RCM & Clinical Documentation (Clinical Background Required)

Compliance Lead - RCM & Clinical Documentation (Clinical Background Required)

Essen Medical Associates

Bronx, NY • On-site, Remote

$75K - $90K/yr

Full-time

Posted 13 days ago

Job description

Overview
Company Overview: At Essen Health Care, we care for that!
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 to 50+ locations and 600+ providers delivering urgent care, primary care, specialty services, nursing home support, and in-home care - guided by a Population Health model across in-person, home, and telehealth settings.
Job Summary
Position Title: Operational Compliance Lead - RCM & Clinical Documentation (Clinical Background Required)
Reporting to: Chief Administrative Officer
Scope: Essen Health Care & Nursing Home Division only
Job Summary: The Operational Compliance Lead is an embedded, frontline role managing day-to-day RCM and clinical operations compliance within Essen Health Care and its Nursing Home division. This is a hands-on operational position - distinct from the corporate compliance function - focused on identifying, correcting, and monitoring coding and billing accuracy before issues escalate to external review. Drawing on a clinical background (IMG preferred) and coding expertise, this Lead works directly with administrative and clinical operations leaders to drive documentation integrity, prevent CMS or state audit exposure, and ensure the organization is always audit-ready.
Responsibilities
Operational Compliance & Chart Review
  • Conduct routine and targeted clinical chart reviews and RCM audits assessing coding accuracy, billing integrity, and documentation completeness across CMS and state-billed services.
  • Proactively monitor for compliance risk patterns; generate ongoing trend reports to flag issues before they escalate to external review.
  • Identify coding discrepancies and billing vulnerabilities with focus on ICD-10-CM, CPT, E&M level selection, and Medical Decision Making (MDM) accuracy.
  • Develop, own, and drive Corrective Action Plans (CAPs) to confirmed completion, including re-audit to validate sustained improvement.

Clinical Coding & RCM Collaboration
  • Apply clinical knowledge to review documentation with a clinician's lens - ensuring diagnoses, MDM, and services support the codes being billed.
  • Work directly with admin and clinical operations leaders on ICD-10-CM, CPT, E&M, HCPCS, and HCC/risk adjustment coding accuracy.
  • Serve as the operational compliance liaison to RCM - bridging clinical documentation, coding, and billing to ensure alignment and defensibility.

Provider & Leadership Education
  • Deliver targeted, clinically grounded education to physicians, NPs, PAs, and staff on documentation best practices and coding compliance.
  • Develop training content on coding standards and payer-specific regulatory requirements as guidelines evolve.

Reporting & CAP Management
  • Produce executive-ready compliance trend reports and audit summaries that inform leadership decisions and prioritize risk.
  • Present CAPs to clinical and administrative leadership with clear timelines, owners, and success metrics - then own follow-through to resolution.
  • Act as the first line of resolution before issues surface at the corporate compliance level; maintain continuous audit readiness.

Qualifications
Qualifications
Required
  • Bachelor's Degree in Healthcare Administration, Nursing, Health Information Management, Public Health, or related field.
  • Clinical background required; International Medical Graduate (IMG) or foreign medical degree highly valued.
  • Active coding certification: CPC, CRC, CCS, or equivalent.
  • Minimum 3 years of operational compliance, coding, clinical chart review, or RCM experience; demonstrated ability to develop and close out CAPs.
  • Strong knowledge of ICD-10-CM, CPT, HCPCS, HCC/Risk Adjustment, Medicare/Medicaid regulations, and HIPAA.
  • Demonstrated ability to present audit findings and CAPs to senior leadership; comfortable owning follow-through to resolution.

Preferred
  • Master's Degree (MHA, MPH, MBA with healthcare focus, MSN, or equivalent) - strongly preferred given the organizational complexity and cross-functional leadership demands of this role.
  • Project management experience or certification (PMP, CAPM, or equivalent).
  • Experience in Medicare Advantage, value-based care, and/or Clinical Documentation Improvement (CDI).
  • Experience with eClinicalWorks (eCW) or similar EMR systems.
  • Prior experience providing provider education and compliance training.

Core Competencies
Clinical Documentation Integrity • Compliance Auditing • RCM & Revenue Integrity • Provider Education & Coaching • HCC/Risk Adjustment Coding • CAP Development & Closure • Regulatory Compliance • Data Analysis & Reporting • Project Management • Cross-Functional Collaboration
Work Environment
  • Full-time | Hybrid or on-site based on business needs | Travel between clinical locations may be required.

Why Join Essen Health Care?
The Operational Compliance Lead plays a uniquely important role at the intersection of clinical knowledge, coding expertise, and operational leadership. This is not a corporate oversight role - it is a proactive, hands-on position embedded within Essen Health Care and Nursing Home operations to identify and resolve compliance issues at the source, before they reach external review. If you are a clinically trained professional who understands how care is delivered and how it must be accurately documented and billed, this is a role where your expertise will have immediate, measurable impact.
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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