Remote Risk Adjustment Auditor - Quality & Coding Expert

Namely; Arizona; Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Medical benefits

Job summary

Oscar Health is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. This remote role supports audits, code abstraction accuracy, and QA initiatives across ACA and MA lines.

You will report to the Manager, Risk Adjustment and work from home with occasional travel for meetings and events. Candidates must reside in AZ, FL, GA, or TX and have CPC plus 3+ years RADV/QA experience.

Qualifications

• Bachelor's degree or commensurate work experience.
• 3+ years retrospective risk adjustment coding experience.
• 1+ year(s) quality auditing and/or RADV experience

Responsibilities

• Conduct daily risk adjustment operations including medical record reviews to report ICD-10-CM codes for ACA and MA lines.
• Validate EDGE data is supported within provider encounter documentation to mitigate risk.
• Review coding team performance and report audit trends to leadership for corrective actions.
• Maintain compliance with ICD-10-CM guidelines and risk adjustment production standards.
• Conduct CMS audits of Risk Adjustment activities including RADV audits.
• Develop relationships to improve understanding of the Risk Adjustment process.

Skills

CPC

RADV experience

Quality auditing

Education

Bachelor's degree

Job description

Oscar Health is hiring an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. This remote role supports audits, code abstraction accuracy, and QA initiatives across ACA and MA lines.

You will report to the Manager, Risk Adjustment and work from home with occasional travel for meetings and events. Candidates must reside in AZ, FL, GA, or TX and have CPC plus 3+ years RADV/QA experience.