Associate, Risk Adjustment Auditor (Fully Remote)

Oscar Health; United States; Remote; USD 75,000 - 105,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Unlimited vacation

11 paid holidays

Paid parental leave

401(k)

Life insurance

Disability insurance

Job summary

Oscar Health is seeking an Associate, Risk Adjustment Auditor to conduct internal and external quality audits of ICD-10 code abstraction and collaborate with management on benchmarks and quality assurance programs.

Responsibilities include medical record reviews, reporting ICD-10-CM codes for ACA and MA lines, validating EDGE data, reporting audit trends, CMS audits, and developing clinical documentation improvement resources.

Qualifications

• Bachelor's degree or commensurate work experience.
• CPC with 3+ years retrospective risk adjustment coding experience.
• 1+ years quality auditing or RADV experience.

Responsibilities

• Perform medical record reviews and report ICD-10-CM diagnosis codes for ACA and MA lines of business.
• Validate EDGE data is supported by provider encounter documentation and report audit trends to leadership.
• Conduct CMS audits and develop clinical documentation improvement resources.

Skills

CPC certification

Risk adjustment coding

Quality auditing

Education

Bachelor's degree

Job description

• The Associate, Risk Adjustment Auditor conducts internal and external quality audits specific to ICD-10 code abstraction.
• Work with management to implement benchmarks and quality assurance programs.

Responsibilities:

• Perform medical record reviews and report ICD-10-CM diagnosis codes for ACA and MA lines of business.
• Validate EDGE data is supported by provider encounter documentation and report audit trends to leadership.
• Conduct CMS audits and develop clinical documentation improvement resources.

Requirements:

• Bachelor's degree or commensurate work experience.
• Certified Professional Coder (CPC) with 3+ years retrospective risk adjustment coding experience.
• 1+ years quality auditing or RADV experience.
• Medical, dental, and vision benefits.
• Unlimited vacation program and 11 paid holidays.
• Paid parental leave, 401(k) plan, life and disability insurance.

Oscar Health

Oscar is a health insurance company built around a full-stack technology platform and a relentless focus on serving its members. Founded in 2012, it cultivates an inclusive environment where employees can be their authentic selves.