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Senior Risk Adjustment Coding Specialist
2 months ago
Welcome to Oscar Health. We are seeking a Senior Risk Adjustment Coder to enhance our Risk Adjustment team.
Oscar Health is pioneering a health insurance model that integrates advanced technology with a commitment to member service. Our journey began in 2012, driven by the desire to create a health insurance experience that feels personal and supportive.
Position SummaryThe Senior Risk Adjustment Specialist will focus on Medicare Advantage (MA) and Affordable Care Act (ACA) business lines, collaborating with management to achieve departmental objectives and comply with guidelines set by regulatory bodies.
You will report directly to the Risk Adjustment Coding Lead.
Work EnvironmentOscar promotes a flexible work culture that fosters connection among team members, regardless of their work arrangement. If you are located within commuting distance of our offices, you will be expected to work on-site a minimum of two days a week. Otherwise, this position allows for remote work.
Eligible states for residency include: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. This list may be updated periodically.
Compensation TransparencyThe salary range for this role varies by location. In California, Connecticut, New Jersey, New York, and Washington, the base pay is between $72,800 and $95,550 annually. For other locations, the range is $65,520 to $85,995 annually. Employees also enjoy comprehensive benefits, an unlimited vacation policy, and performance-based bonuses.
Key Responsibilities- Oversee daily Risk Adjustment operations, including medical record evaluations to assign ICD-10-CM diagnosis codes for ACA and MA lines, manage potential CMS audits, and coordinate medical record retrieval.
- Ensure adherence to national coding standards and practices as outlined by ICD-10-CM guidelines, maintaining accuracy and compliance with Risk Adjustment production standards.
- Engage in CMS audits related to Risk Adjustment activities, including Risk Adjustment Data Validation audits.
- Build and maintain relationships with key stakeholders to enhance understanding of the Risk Adjustment process.
- Identify opportunities for document improvement to educate providers in both MA and ACA lines of business.
- Propose process enhancements to improve the efficiency of medical encounter reviews.
- Comply with all relevant laws and regulations.
- Perform additional duties as assigned.
- Bachelor's degree in a relevant field or equivalent professional experience.
- Certification as a professional coder (CPC).
- A minimum of 2 years of experience in retrospective risk adjustment coding.
- Certification as a Risk Adjustment Coder (CRC) or similar.
- Experience with various Electronic Medical Record (EMR) systems.
At Oscar, we are committed to fostering an inclusive environment where everyone can thrive. We are dedicated to changing the healthcare landscape through diverse perspectives and experiences.
Compensation Transparency: Final salary offers are based on various factors, including skills, education, and experience. Full-time employees are eligible for a range of benefits, including medical, dental, and vision coverage, paid holidays, sick leave, parental leave, participation in a 401(k) plan, life and disability insurance, and wellness programs.
Reasonable Accommodation: Oscar is committed to providing equal employment opportunities and considers applicants based solely on qualifications. Any applicant requiring reasonable accommodations during the application process should contact the Oscar Benefits Team.
