Risk Adjustment Coder Specialist

1 hour, 34 minutes ago
Full-time
Junior
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 daily risk adjustment operations, including medical record reviews and ICD-10-CM diagnosis code reporting for ACA and Medicare Advantage lines of business.
  • Support medical record retrieval efforts and potential CMS audits related to risk adjustment.
  • Maintain compliance with ICD-10-CM coding guidelines, national standards, and risk adjustment production standards.
  • Participate in CMS audits of risk adjustment activities, including Risk Adjustment Data Validation audits.
  • Develop relationships with key stakeholders to improve understanding of the risk adjustment process.
  • Support identification of documentation improvement opportunities for provider education across MA and ACA lines of business.
  • Identify process improvements to increase efficiency in medical encounter review workflows.
  • Comply with all applicable laws and regulations.
  • Perform other duties as assigned.

Requirements

  • Bachelor's degree in a relevant field or equivalent work experience.
  • Certified Professional Coder (CPC) certification.
  • 2+ years of retrospective risk adjustment coding experience.
  • Remote candidates must reside in Arizona, Florida, Georgia, or Texas.
  • Preferred: Certified Risk Adjustment Coder (CRC) or similar certification.
  • Preferred: Experience coding in multiple Electronic Medical Record (EMR) systems.

Benefits

  • Base salary of $67,813 to $89,004 per year.
  • Eligible for annual performance bonuses.
  • Eligible for Oscar's 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.
  • Paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

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