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Salary: USD 82,717 - 108,566 / annual
Oscar Health is seeking an Associate Risk Adjustment Auditor to join its Risk Adjustment team. Oscar is a health insurance company built on a full-stack technology platform, founded in 2012 with a focus on member-centric care.
In this role, you will conduct internal and external quality audits focused on ICD-10 code abstraction, evaluating accuracy, completeness, and identifying clinical documentation improvement opportunities. You will work with management to implement benchmarks, establish acceptable thresholds, and develop quality assurance programs. You report to the Manager, Risk Adjustment.
Key responsibilities include:
- Performing daily Risk Adjustment operations, including medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business
- Validating Encounter Data Gathering Environment Server (EDGE) data against provider encounter documentation to mitigate risk
- Reviewing the performance of the Risk Adjustment Coding team and reporting audit trends to leadership
- Maintaining compliance with ICD-10-CM coding guidelines and Risk Adjustment production standards
- Conducting CMS audits of Risk Adjustment activities, including Risk Adjustment Data Validation (RADV) audits
- Developing relationships with key stakeholders to foster understanding of the Risk Adjustment process
- Creating clinical document improvement resources for provider education across MA and ACA lines of business
- Managing implementation of process improvements to maximize risk adjustment factor increases
- Ensuring compliance with all applicable laws and regulations
This is a remote position open to candidates residing in Arizona, Florida, Georgia, or Texas. Occasional travel may be required for team meetings and company events.
Requirements:
- Bachelor's degree in a relevant field of study or commensurate work experience
- Certified Professional Coder (CPC) certification
- 3+ years of retrospective risk adjustment coding experience
- 1+ year of quality auditing and/or Risk Adjustment Data Validation Audit (RADV) experience
Bonus qualifications:
- Certified Risk Adjustment Coder (CRC) or similar certification
- Experience coding in a variety of Electronic Medical Record (EMR) systems
