Remote Risk Adjustment Auditor | Quality & Compliance

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

Benefits offered by this job

Unlimited vacation

Annual performance bonuses

Job summary

Oscar Health is hiring an Associate, Risk Adjustment Auditor to conduct internal and external quality audits focused on ICD-10 code abstraction and accuracy. You will work with management to set benchmarks, thresholds, and QA programs, reporting to the Manager, Risk Adjustment. This is a remote role open to multiple states, with potential travel for meetings and events.

The base pay ranges from $82,717 to $108,566 per year plus benefits, unlimited vacation, and annual performance bonuses.

Qualifications

• Bachelor's degree in a relevant field of study or commensurate work experience.
• Certified professional coder (CPC)
• 3+ year(s) retrospective risk adjustment coding experience.
• 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Responsibilities

• Daily operations for Risk Adjustment including medical record reviews and ICD-10-CM coding for ACA and MA lines.
• Validate EDGE data alignment with provider documentation to mitigate risk.
• Monitor and report audit trends to leadership and implement education changes.
• Ensure compliance with ICD-10-CM guidelines and risk adjustment production standards.
• Conduct CMS audits of Risk Adjustment activities (RADV).
• Develop relationships to improve risk adjustment processes and provider education.

Skills

CPC certification

Risk adjustment coding

RADV auditing

Education

Bachelor's degree or commensurate experience

Job description

Oscar Health is hiring an Associate, Risk Adjustment Auditor to conduct internal and external quality audits focused on ICD-10 code abstraction and accuracy. You will work with management to set benchmarks, thresholds, and QA programs, reporting to the Manager, Risk Adjustment. This is a remote role open to multiple states, with potential travel for meetings and events.

The base pay ranges from $82,717 to $108,566 per year plus benefits, unlimited vacation, and annual performance bonuses.