Remote Risk Adjustment Auditor — Quality & Compliance

name; Georgia; Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Unlimited vacation

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Job summary

Oscar Health is seeking an Associate, Risk Adjustment Auditor to perform internal and external quality audits focused on ICD-10 code abstraction accuracy and documentation improvements. You will help implement benchmarks, thresholds, and QA programs while supporting CMS and HHS audits.

The role is remote for candidates in AZ, FL, GA, or TX, with travel to team meetings as needed. Competitive base pay, benefits, unlimited vacation, and annual bonuses are included.

Qualifications

• Bachelor's degree or commensurate work experience.
• CPC certification required.
• 3+ years retrospective risk adjustment coding experience.
• 1+ year RADV or quality auditing experience preferred.

Responsibilities

• Perform ICD-10-CM coding reviews for ACA/MA lines and identify documentation improvements.
• Audit QA processes and report trends to leadership for corrective actions.
• Ensure compliance with ICD-10-CM guidelines and risk adjustment standards.
• Lead risk adjustment data validation activities and CMS audits as needed.
• Collaborate with provider education teams to improve documentation.

Skills

CPC certification

Risk adjustment coding

Quality auditing

RADV experience

Education

Bachelor's degree or commensurate experience

Tools

Electronic Medical Records (EMR) systems

Job description

Oscar Health is seeking an Associate, Risk Adjustment Auditor to perform internal and external quality audits focused on ICD-10 code abstraction accuracy and documentation improvements. You will help implement benchmarks, thresholds, and QA programs while supporting CMS and HHS audits.

The role is remote for candidates in AZ, FL, GA, or TX, with travel to team meetings as needed. Competitive base pay, benefits, unlimited vacation, and annual bonuses are included.