Remote Risk Adjustment Auditor: Elevate Coding Quality

name; Town of Texas (WI); Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Unlimited vacation program

Annual performance bonuses

Benefits package

Job summary

Oscar Health is seeking an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. The role conducts internal and external quality audits focusing on ICD-10 code abstraction accuracy and opportunities for documentation improvement.

You will report to the Manager, Risk Adjustment and help implement QA benchmarks. This remote position is open to residents in AZ, FL, GA, or TX, with occasional travel for team meetings.

Qualifications

• Bachelor's degree in a relevant field or commensurate work experience.
• Certified Professional Coder (CPC).
• 3+ years retrospective risk adjustment coding experience.
• 1+ year Quality Auditing and/or RADV auditing experience.

Responsibilities

• Conduct daily operations for Risk Adjustment including medical record reviews and reporting ICD-10-CM codes.
• Mitigate risk by validating EDGE data is supported within provider documentation.
• Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership.
• Maintain compliance with ICD-10-CM guidelines and Risk Adjustment standards.
• Conduct CMS audits of RADV activities.
• Develop relationships to foster understanding of the Risk Adjustment process.
• Identify and create clinical document improvement resources for provider education.
• Manage implementation of process improvements to maximize risk adjustment factors.
• Comply with applicable laws and regulations.
• Other duties as assigned.

Skills

Risk Adjustment Coding

Quality Auditing

RADV Audits

Education

Bachelor's degree or commensurate experience

Job description

Oscar Health is seeking an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. The role conducts internal and external quality audits focusing on ICD-10 code abstraction accuracy and opportunities for documentation improvement.

You will report to the Manager, Risk Adjustment and help implement QA benchmarks. This remote position is open to residents in AZ, FL, GA, or TX, with occasional travel for team meetings.