Remote Risk Adjustment Auditor — Quality & Compliance

Oscar-Health-; Dallas (TX); Remote; USD 83,000 - 109,000; Full time

Job summary

Oscar Health is seeking an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. The role focuses on ICD-10 code abstraction quality, accuracy, and documentation improvement opportunities, reporting to the Manager, Risk Adjustment.

This remote position welcomes candidates in AZ, FL, GA, or TX. Daily work is from home with occasional travel for team meetings and events. Base pay ranges from $82,717 to $108,566 per year, plus benefits and bonuses.

Qualifications

• Bachelor's degree in a relevant field or commensurate work experience.
• Certified professional coder (CPC) or equivalent.
• 3+ years retrospective risk adjustment coding experience.
• 1+ year experience in Quality Auditing and/or RADV.
• Certified Risk Adjustment Coder (CRC) or similar certification.
• Experience coding in various EMR systems.

Responsibilities

• Conduct internal and external quality audits focusing on ICD-10 code abstraction for ACA and MA lines.
• Collaborate with management to implement benchmarks and QA programs.
• Monitor audit trends and communicate findings to leadership for corrective actions.
• Ensure compliance with ICD-10-CM guidelines and risk adjustment standards.
• Conduct CMS RADV audits and develop provider education resources.
• Support process improvements to maximize risk adjustment factors.
• Maintain adherence to applicable laws and regulations.
• Foster relationships to improve the risk adjustment process.

Education

Bachelor's degree or commensurate work experience

Tools

CPC Certification

CRC Certification

RADV auditing experience

EMR systems experience

Job description

Oscar Health is seeking an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. The role focuses on ICD-10 code abstraction quality, accuracy, and documentation improvement opportunities, reporting to the Manager, Risk Adjustment.

This remote position welcomes candidates in AZ, FL, GA, or TX. Daily work is from home with occasional travel for team meetings and events. Base pay ranges from $82,717 to $108,566 per year, plus benefits and bonuses.