Risk Adjustment Coder Specialist
Hi, we're Oscar. We're hiring a Senior Specialist to join our Risk Adjustment team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role
The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing Risk Adjustment processes.
You will report to the Associate Director, Risk Adjustment.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
This is a hybrid role in our New York office. You will work part of the time in the office and part of the time remote / work-from-home. #LI-Hybrid
Pay Transparency:
The base pay for this role is: $72,800 - $95,550 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.
Responsibilities
- Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential CMS audits and medical record retrieval efforts.
- Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
- Participate in CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
- Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
- Support in the identification of document improvement opportunities for provider education in both MA and ACA line of business.
- Identify process improvements to enhance medical encounter review efficiency.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- Bachelor's degree in a relevant field of study or commensurate work experience.
- Certified professional coder (CPC)
- 2+ year(s) retrospective risk adjustment coding experience.
Bonus points
- Certified Risk Adjustment Coder (CRC) or similar certification
- Experience coding in a variety of different Electronic Medical Record (EMR) systems.
Travel
- Up to 5%
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
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Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
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California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.
Perks and Benefits
Health and Wellness
- Pet Insurance
- Mental Health Benefits
- FSA
- HSA
- Fitness Subsidies
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Short-Term Disability
- Long-Term Disability
Parental Benefits
- Adoption Leave
- Fertility Benefits
- Family Support Resources
- Non-Birth Parent or Paternity Leave
- Birth Parent or Maternity Leave
- Return-to-Work Program
Work Flexibility
- Remote Work Opportunities
- Flexible Work Hours
- Hybrid Work Opportunities
Office Life and Perks
- Happy Hours
- Commuter Benefits Program
- Casual Dress
- Snacks
Vacation and Time Off
- Personal/Sick Days
- Paid Holidays
- Paid Vacation
Financial and Retirement
- Company Equity
- Performance Bonus
- Financial Counseling
- 401(K) With Company Matching
Professional Development
- Internship Program
- Leadership Training Program
- Access to Online Courses
- Mentor Program
Diversity and Inclusion
- Employee Resource Groups (ERG)
- Diversity, Equity, and Inclusion Program
Company Videos
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