Remote Risk Adjustment Auditor - Quality and Compliance

Oscar Health; Florida; Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Medical, dental, and vision benefits

11 paid holidays

Paid sick time

Parental leave

401(k) plan

Job summary

Oscar Health in the United States is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. This role involves conducting internal and external quality audits focused on ICD-10 code abstraction, accuracy, and documentation improvement opportunities.

You will report to the Manager, Risk Adjustment and work remotely from home. The position is open to candidates in Arizona, Florida, Georgia, or Texas with occasional travel for meetings and events.

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(s) experience Quality Auditing and/or RADV audits.

Responsibilities

• Daily operations for Risk Adjustment including medical record reviews and ICD-10-CM reporting for ACA and MA lines.
• Validate EDGE data is supported within provider encounter documentation.
• Review audit trends and inform leadership to implement corrective actions.
• Maintain compliance with ICD-10-CM guidelines and Risk adjustment production standards.
• Conduct CMS audits of Risk Adjustment activities, including RADV audits.

Education

Bachelor's degree or commensurate work experience

Certified professional coder (CPC)

Job description

Oscar Health in the United States is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. This role involves conducting internal and external quality audits focused on ICD-10 code abstraction, accuracy, and documentation improvement opportunities.

You will report to the Manager, Risk Adjustment and work remotely from home. The position is open to candidates in Arizona, Florida, Georgia, or Texas with occasional travel for meetings and events.