Risk Adjustment Coder Specialist

1 month ago
Full-time
Senior
Operations
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

  • Perform medical record reviews and report ICD-10-CM diagnosis codes for ACA and MA lines of business.
  • Manage daily risk adjustment operations, including medical record retrieval and preparation for potential CMS audits.
  • Maintain accuracy and compliance with ICD-10-CM coding guidelines and risk adjustment production standards.
  • Participate in CMS audits of risk adjustment activities, including Risk Adjustment Data Validation (RADV) audits.
  • Develop relationships with internal and external stakeholders to increase understanding of the risk adjustment process.
  • Identify and support provider education opportunities to improve documentation for MA and ACA lines of business.
  • Recommend and implement process improvements to increase efficiency of medical encounter review.
  • Ensure compliance with all applicable laws and regulations related to risk adjustment activities.

Requirements

  • Bachelor's degree in a relevant field or commensurate work experience.
  • Certified Professional Coder (CPC).
  • 2+ years of retrospective risk adjustment coding experience.
  • Ability to meet deadlines and requirements set by CMS and HHS.
  • Must reside in Arizona, Florida, Georgia, or Texas (remote role) and be available for occasional travel for team meetings and company events.
  • Certified Risk Adjustment Coder (CRC) or similar certification (preferred).
  • Experience coding in a variety of Electronic Medical Record (EMR) systems (preferred).

Benefits

  • Base pay range $67,813 - $89,004 per year.
  • Medical, dental, and vision benefits.
  • Participation in Oscar's unlimited vacation program.
  • Annual performance bonuses.
  • 11 paid holidays and paid sick time.
  • Paid parental leave.
  • 401(k) plan participation.
  • Life and disability insurance, plus paid wellness time and wellness reimbursements.

Interested in this position?

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