Remote Risk Adjustment Auditor - Quality & Compliance

Oscar Health; Phoenix (AZ); Remote; USD 83,000 - 109,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

11 paid holidays

Paid sick time

Paid parental leave

401(k) plan participation

Life and disability insurance

Wellness time and reimbursements

Job summary

Oscar Health is seeking an Associate, Risk Adjustment Auditor to conduct internal and external quality audits focusing on ICD-10 code abstraction accuracy and documentation improvement opportunities.

This remote role is open to candidates residing in AZ, FL, GA, or TX, with occasional travel for meetings. Base pay ranges from $82,717 to $108,566 annually, plus benefits and performance bonuses.

Qualifications

• Bachelor's degree or commensurate work experience.
• CPC certification with 3+ years retrospect ive risk adjustment coding experience.
• 1+ year experience Quality Auditing and/or RADV audits.

Responsibilities

• Conduct daily risk adjustment operations including medical record reviews to report ICD-10-CM codes for ACA and MA lines of business.
• Validate EDGE data is supported within provider encounter documentation to mitigate risk.
• Review Risk Adjustment Coding team performance and report audit trends to Leadership for action.
• Ensure ICD-10-CM coding guidelines compliance and risk adjustment production standards.

Skills

CPC certification

RADV experience

Quality auditing

Education

Bachelor's degree or commensurate experience

Tools

EMR systems

Job description

Oscar Health is seeking an Associate, Risk Adjustment Auditor to conduct internal and external quality audits focusing on ICD-10 code abstraction accuracy and documentation improvement opportunities.

This remote role is open to candidates residing in AZ, FL, GA, or TX, with occasional travel for meetings. Base pay ranges from $82,717 to $108,566 annually, plus benefits and performance bonuses.