Risk Adjustment Coder Specialist

Oscar Health

🔍 Observed

$68K - $89K USD

Miami, Florida, United States First seen 3 weeks ago Last seen 7 hours, 10 minutes ago Greenhouse

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Job Description

AI Summary

• Reviews medical records and reports ICD-10-CM diagnosis codes for Medicare Advantage and ACA insurance lines while ensuring compliance with coding standards and CMS regulations. • Requires a Bachelor's degree, Certified Professional Coder (CPC) credential, and 2+ years of retrospective risk adjustment coding experience. • Participates in CMS audits, identifies process improvements, and collaborates with providers on document enhancement and Risk Adjustment education initiatives. • Remote position based in Arizona, Florida, Georgia, or Texas with occasional travel; salary ranges from $67,813-$89,004 annually plus benefits, unlimited vacation, and performance bonuses. • Preferred qualifications include Certified Risk Adjustment Coder (CRC) certification and experience with multiple Electronic Medical Record (EMR) systems.

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes.

You will report into the Manager, Risk Adjustment.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential CMS audits and medical record retrieval efforts.
Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
Participate in CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
Support in the identification of document improvement opportunities for provider education in both MA and ACA line of business.
Identify process improvements to enhance medical encounter review efficiency.
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

Bachelor's degree in a relevant field of study or commensurate work experience.
Certified professional coder (CPC)
2+ year(s) retrospective risk adjustment coding experience.

Bonus points:

Certified Risk Adjustment Coder (CRC) or similar certification
Experience coding in a variety of different Electronic Medical Record (EMR) systems.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

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Job Information

Company:
Oscar Health
Location:
Miami, Florida, United States
Experience Level:
Mid
Source:
Greenhouse
Status:
Active

Activity Score

68 /100

Likely Active (68)

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