Senior Risk Adjustment Coder Specialist

11 hours ago

New York, New York, United States Oscar Health Full time
About the Role

Oscar Health is seeking a highly skilled Senior Risk Adjustment Coder Specialist to join our Risk Adjustment team. As a key member of our team, you will be responsible for daily operations related to Risk Adjustment, including medical record reviews, potential CMS audits, and medical record retrieval efforts.

Key responsibilities include maintaining compliance with national standards and coding practices set by the ICD-10-CM coding guidelines, participating in CMS audits, and developing relationships with key individuals to foster an increased understanding of the Risk Adjustment process.

Additionally, you will support the identification of document improvement opportunities for provider education in both MA and ACA lines of business, and identify process improvements to enhance medical encounter review efficiency.

This is an exciting opportunity to work with a dynamic team and contribute to the success of Oscar Health.

Responsibilities:

  • Responsible for daily operations about Risk Adjustment including: 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, and 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 main 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.

Qualifications:

  • 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 multiple different Electronic Medical Record (EMR) systems.

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