Remote Risk Adjustment Auditor — Quality & Coding

Oscar-Health-; Grand Est; Remote; EUR 73,000 - 96,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonuses

Job summary

Oscar Health is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. You will conduct internal and external quality audits focused on ICD-10 code abstraction, accuracy and documentation improvements.

You will report to the Manager, Risk Adjustment, with responsibilities spanning CMS/HHS audits, EDGE data validation, and ongoing process improvements while maintaining compliance with ICD-10-CM guidelines.

Qualifications

• Bachelor's degree or commensurate work experience.
• CPC certification required.
• 3+ years retrospective risk adjustment coding experience.
• 1+ year experience in Quality Auditing and/or RADV audits.
• CRC or similar certification.

Responsibilities

• Perform daily Operations for Risk Adjustment incl. medical record reviews for ICD-10-CM codes.
• Validate EDGE data is supported within provider documentation to mitigate risk.
• Review QA trends and report findings to leadership for corrective actions.
• Maintain compliance with ICD-10-CM guidelines and risk adjustment standards.
• Conduct CMS audits of Risk Adjustment activities (RADV, etc.).
• Develop resources for provider education in MA and ACA lines.
• Lead process improvements to maximize risk adjustment factors.
• Ensure compliance with applicable laws and regulations.
• Perform other duties as assigned.

Skills

Quality auditing

Risk adjustment coding

EMR experience

Education

Bachelor's degree in a relevant field

Certified Risk Adjustment Coder (CRC)

CPC certification

Tools

EMR systems

CMS/HHS auditing tools

Job description

Oscar Health is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. You will conduct internal and external quality audits focused on ICD-10 code abstraction, accuracy and documentation improvements.

You will report to the Manager, Risk Adjustment, with responsibilities spanning CMS/HHS audits, EDGE data validation, and ongoing process improvements while maintaining compliance with ICD-10-CM guidelines.