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Senior Hcc Risk Adjustment Coder Jobs in New York

Essen Healthcare

Be Seen First

Director of Coding Compliance

Bronx, NY · On-site

$85K - $110K/yr

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.

Healthfirst (New York)

Hybrid Coding Educator

New York, NY

$29.75 - $34/hr

Responsible for auditing clinical documentation encounters to validate Risk Adjustment and HCCs Responsible for managing and responding to provider inquiries via the coding hotline as well. * Trains ...

Healthfirst

Hybrid Coding Educator

Manhattan, NY · On-site

$30 - $34.25/hr

Responsible for auditing clinical documentation encounters to validate Risk Adjustment and HCCs Responsible for managing and responding to provider inquiries via the coding hotline as well. * Trains ...

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Senior Hcc Risk Adjustment Coder information

What does a Senior HCC Risk Adjustment Coder do?

A Senior HCC Risk Adjustment Coder reviews medical records and assigns appropriate ICD-10 codes to ensure accurate risk adjustment for healthcare organizations. Their work supports proper reimbursement and compliance by identifying and coding Hierarchical Condition Categories (HCCs) based on clinical documentation. Senior coders typically have advanced knowledge of coding guidelines, risk adjustment models, and relevant regulations such as Medicare Advantage requirements. They may also audit coding work, provide training, and help implement best practices within their teams.

What are some common challenges faced by Senior HCC Risk Adjustment Coders, and how can they be addressed?

Senior HCC Risk Adjustment Coders often encounter challenges such as keeping up with frequent coding guideline updates, navigating complex electronic health record systems, and ensuring accurate documentation to support risk adjustment scores. To address these, staying current with industry training and certification requirements is essential, as is developing strong communication skills to collaborate effectively with providers and other coding professionals. Regular auditing and feedback can also help maintain high accuracy and compliance, contributing to both individual and team success.

What are the key skills and qualifications needed to thrive as a Senior HCC Risk Adjustment Coder?

To thrive as a Senior HCC Risk Adjustment Coder, you need in-depth knowledge of ICD-10-CM coding, risk adjustment methodologies, and a relevant credential such as CPC, CRC, or CCS. Familiarity with coding software, EHR systems, and risk adjustment analytics platforms is essential. Attention to detail, analytical thinking, and strong communication skills distinguish top performers in this role. These skills ensure accurate documentation and coding, directly impacting healthcare organizations' compliance and financial outcomes.
What are the most commonly searched types of Hcc Risk Adjustment Coder jobs in New York? The most popular types of Hcc Risk Adjustment Coder jobs in New York are:
What cities in New York are hiring for Senior Hcc Risk Adjustment Coder jobs? Cities in New York with the most Senior Hcc Risk Adjustment Coder job openings:
Senior Hcc Risk Adjustment Coder jobs near you

Senior Medical Economics Analyst

HealthCare Partners, MSO

Garden City, NY • On-site

$88K - $109K/yr

Full-time

Medical, Dental, Retirement, PTO

Re-posted 24 days ago

Job description

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.
HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care.  Interested in joining our successful Garden City Team?
Position Summary: The Senior Medical Economics Analyst serves as a key contributor to the organization’s financial and clinical performance by delivering advanced analytics on total cost of care, utilization, and value-based contract performance. This role is responsible for translating complex healthcare data, including claims, capitation, and provider performance metrics into actionable insights that support strategic decision-making across Finance, Operations, and Clinical Leadership.
This position combines financial acumen with healthcare analytics expertise to evaluate trends in medical cost, utilization, and reimbursement, identify drivers of performance, and recommend interventions that improve profitability, quality outcomes, and risk-based contract success. The role operates at the intersection of FP&A, actuarial analytics, and population health, supporting the organization’s transition toward value-based care.
Essential Position Functions/Responsibilities:
Medical Economics & Cost of Care Analytics
  • Analyze total cost of care (TCOC), including inpatient, outpatient, professional, and pharmacy spend, to identify key cost drivers and emerging trends
  • Evaluate utilization metrics (e.g., admits/1,000, ER visits/1,000, SNF utilization, specialty referral patterns) and cost per unit to assess performance against benchmarks
  • Perform detailed variance analysis across populations, products, and payer contracts to explain financial performance
  • Identify drivers of unfavorable medical cost trends and recommend targeted interventions (e.g., utilization management, site-of-care optimization, payment integrity)

Value-Based Contracting & Risk Performance
  • Analyze financial performance of capitation, shared savings, and risk-based contracts, including surplus/deficit, MLR, and settlement projections
  • Develop models to assess the financial impact of payer rate changes, contract terms, and attribution shifts
  • Partner with contracting and network teams to evaluate reimbursement structures and provider incentives
  • Support risk adjustment analytics (RAF/HCC capture, coding accuracy) where applicable
Financial Modeling & Forecasting
  • Develop and maintain robust financial and actuarial models to forecast medical expense trends and utilization patterns
  • Support budgeting and forecasting processes for medical cost and risk-based revenue streams
  • Perform scenario modeling to assess financial impact of strategic initiatives, population growth, or changes in care delivery
  • Collaborate with FP&A leadership to integrate medical economics into enterprise financial planning
Cross-Functional Collaboration
  • Partner with Clinical, Operations, Care Management, and Network teams to align financial insights with care delivery initiatives
  • Partner with Information Technologies Business Intelligence Unit for data extraction and production processes for dashboards and scheduled reports
  • Support population health strategies through data-driven identification of high-cost cohorts and intervention opportunities
  • Translate analytical findings into actionable recommendations for non-financial stakeholders
  • Serve as a subject matter resource for medical economics across the organization
Performance Monitoring & Continuous Improvement
  • Develop and monitor key performance indicators (KPIs) related to cost, utilization, quality, and contract performance
  • Track effectiveness of cost containment and performance improvement initiatives
  • Identify opportunities to enhance data infrastructure, analytics capabilities, and reporting processes
  • Stay current on healthcare reimbursement models, regulatory changes, and industry best practices

Qualification Requirements:
Skills, Knowledge, Abilities
  • Strong knowledge of healthcare finance, medical economics, and managed care principles (capitation, risk adjustment, TCOC)
  • Advanced analytical and financial modeling skills, including large dataset manipulation and statistical analysis
  • Proficiency in SQL and advanced Excel (modeling, pivot tables, VBA); experience with BI tools (Tableau, Power BI)
  • Ability to synthesize complex data into clear, actionable insights for executive audiences
  • Understanding of claims data structures, provider reimbursement methodologies, and utilization metrics
  • Strong problem-solving skills with attention to detail and data accuracy
  • Excellent communication and presentation skills, with the ability to influence cross-functional stakeholders
Training/Education:
  • Bachelor’s degree in Finance, Accounting, Economics, Actuarial Science, Public Health, or related field required
  • Master’s degree (MBA, MPH, or related) or relevant certifications (e.g., CFA, ASA progress) preferred
Experience:
  • Minimum of 5–7 years of experience in healthcare analytics, medical economics, FP&A, or managed care finance
  • Experience in an IPA, MSO, health plan, or value-based care environment strongly preferred
  • Demonstrated experience working with claims data, cost of care analysis, and financial forecasting
  • Experience supporting risk-based or capitated contract performance preferred

Our website: HealthCare Partners
Base Compensation: $125,000 - $140,000 annually 
Bonus Incentive: Eligibility based off organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)
Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.
 

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