Risk Adjustment Coder Specialist

1 hour, 43 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 review and ICD-10-CM diagnosis coding for ACA and Medicare Advantage lines of business.
  • Support medical record retrieval efforts and potential CMS audit activities.
  • Maintain compliance with ICD-10-CM coding guidelines, national standards, and Risk Adjustment production standards.
  • Participate in CMS audits, including Risk Adjustment Data Validation audits.
  • Develop relationships with key stakeholders to strengthen understanding of the Risk Adjustment process.
  • Identify documentation improvement opportunities to support provider education across MA and ACA lines of business.
  • Identify process improvements to improve medical encounter review efficiency.
  • Ensure compliance with all applicable laws and regulations.
  • Perform other duties as assigned.

Requirements

  • Bachelor's degree in a relevant field or commensurate work experience.
  • Certified Professional Coder (CPC) certification.
  • 2+ years of retrospective risk adjustment coding experience.
  • Certified Risk Adjustment Coder (CRC) or similar certification is preferred.
  • Experience coding in a variety of Electronic Medical Record (EMR) systems is preferred.
  • Ability to work remotely from Arizona, Florida, Georgia, or Texas.
  • Willingness to complete occasional travel for team meetings and company events.

Benefits

  • Base salary of $67,813 to $89,004 per year.
  • Eligibility for annual performance bonuses.
  • Unlimited vacation program.
  • Medical, dental, and vision insurance.
  • 11 paid holidays.
  • Paid sick time.
  • Paid parental leave.
  • 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

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