Auditor, Risk Adjustment

1 week, 6 days ago
Full-time
Junior
Quality Assurance and Testing
Oscar

Oscar

Oscar is a health insurance company that offers plans for individuals, families, and small businesses. With a focus on humanizing health care through technology, design, and data, Oscar provides easy-to-understand bills, 24/7 access to doctors, and a p...

Insurance
1K-5K
Founded 2012

Description

  • Conduct daily risk adjustment operations, including medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business.
  • Support medical record retrieval efforts and prepare for potential CMS and HHS audits.
  • Validate that EDGE data is supported by provider encounter documentation to mitigate risk.
  • Review Risk Adjustment Coding team performance and communicate audit trends to leadership in a timely and effective manner.
  • Maintain compliance with ICD-10-CM coding guidelines, national standards, and risk adjustment production standards.
  • Conduct CMS audits of risk adjustment activities, including Risk Adjustment Data Validation (RADV) audits.
  • Build relationships with key stakeholders to improve understanding of the risk adjustment process.
  • Create and execute clinical documentation improvement resources for provider education across MA and ACA lines of business.
  • Manage process improvements that maximize risk adjustment factor increases.
  • Perform other duties as assigned.

Requirements

  • Bachelor's degree in a relevant field 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 (RADV) experience.
  • Experience in risk adjustment coding for ACA and MA lines of business.
  • Preferred: Certified Risk Adjustment Coder (CRC) or similar certification.
  • Preferred: Experience coding in a variety of Electronic Medical Record (EMR) systems.

Benefits

  • Remote work from eligible locations: Arizona, Florida, Georgia, or Texas.
  • Base salary of $82,717 to $108,566 per year.
  • Unlimited vacation program.
  • Annual performance bonuses.
  • Medical, dental, and vision insurance.
  • 11 paid holidays.
  • Paid sick time and paid parental leave.
  • 401(k) plan, life and disability insurance, and paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

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