Auditor, Risk Adjustment

1 week, 1 day 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 internal and external quality audits focused on ICD-10 code abstraction accuracy, completeness, and clinical documentation improvement opportunities.
  • Perform daily Risk Adjustment operations, including medical record reviews for ICD-10-CM diagnosis code reporting for ACA and MA lines of business.
  • Support CMS, HHS, and Risk Adjustment Data Validation (RADV) audit activities and related medical record retrieval efforts.
  • Validate that EDGE data is supported by provider encounter documentation to mitigate risk.
  • Review Risk Adjustment Coding team performance and report 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.
  • Develop relationships with key stakeholders to improve understanding of the Risk Adjustment process.
  • Create and execute clinical documentation improvement resources for provider education in MA and ACA lines of business.
  • Manage process improvements that help maximize risk adjustment factor increases.
  • Ensure compliance with all applicable laws and regulations.

Requirements

  • Bachelor's degree in a relevant field or equivalent 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) audit experience.
  • Certified Risk Adjustment Coder (CRC) or similar certification is preferred.
  • Experience coding in a variety of Electronic Medical Record (EMR) systems is preferred.
  • Must reside in Arizona, Florida, Georgia, or Texas for this remote role.

Benefits

  • Base salary of $82,717 - $108,566 per year.
  • Eligible for annual performance bonuses.
  • Unlimited vacation program.
  • Medical, dental, and vision benefits.
  • 11 paid holidays.
  • Paid sick time and paid parental leave.
  • 401(k) plan participation.
  • Life and disability insurance, plus paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

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