Remote Risk Adjustment Audit Specialist

Oscar-Health-; Miami (FL); Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Benefits package

Job summary

Oscar Health is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. The role focuses on ICD-10 abstraction accuracy and documentation improvement, with exposure to CMS and RADV audits. You will report to the Manager, Risk Adjustment and work remotely from eligible states.

The position requires a bachelor’s degree, CPC, CRC or similar certification, plus 3+ years of retrospective risk adjustment coding and 1+ year of quality auditing experience. Travel may be required.

Qualifications

• Bachelor’s degree or commensurate work experience.
• CPC certification required; CRC or similar preferred.
• 3+ years retrospective risk adjustment coding experience.
• 1+ year RADV experience or equivalent quality auditing exposure.
• Experience coding in various EMR systems.

Responsibilities

• Conduct internal and external quality audits of ICD-10 code abstraction.
• Identify accuracy, completeness, and documentation improvement opportunities.
• Report audit trends to leadership and support education changes.
• Ensure compliance with ICD-10-CM guidelines and risk adjustment standards.
• Participate in CMS/RADV audits and data validation activities.
• Collaborate to develop clinical documentation improvement resources.

Skills

Audit experience

Quality auditing

Risk adjustment knowledge

Attention to detail

Education

Bachelor's degree in a relevant field

CPC

CRC

Tools

EMR systems

Job description

Oscar Health is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. The role focuses on ICD-10 abstraction accuracy and documentation improvement, with exposure to CMS and RADV audits. You will report to the Manager, Risk Adjustment and work remotely from eligible states.

The position requires a bachelor’s degree, CPC, CRC or similar certification, plus 3+ years of retrospective risk adjustment coding and 1+ year of quality auditing experience. Travel may be required.