Remote Risk Adjustment Auditor — Quality & Compliance

Oscar Health; United States; 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. This remote role supports audits of ICD-10 coding accuracy and clinical documentation improvement across MA and ACA lines.

Based in the United States with residence in AZ, FL, GA, or TX, you will conduct internal and external quality audits, help set benchmarks, and work with leadership to implement QA programs, reporting findings to management and ensuring compliance.

Qualifications

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

Responsibilities

• Perform daily risk adjustment coding and medical record reviews for ACA/MA lines.
• Audit ICD-10-CM coding accuracy and identify documentation improvements.
• Monitor audit trends and report to leadership to drive education and changes.
• Ensure compliance with ICD-10-CM guidelines and production standards.
• Conduct CMS RADV audits and related risk adjustment activities.
• Collaborate with stakeholders to educate providers on improvement opportunities.
• Support implementation of processes to increase risk adjustment factors.
• Maintain compliance with applicable laws and regulations.

Skills

Risk adjustment coding

Quality auditing

EDGE data verification

CMS RADV audits

Education

Bachelor’s degree in a relevant field

CPC certification

Tools

EMR systems

Job description

Oscar Health is seeking an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. This remote role supports audits of ICD-10 coding accuracy and clinical documentation improvement across MA and ACA lines.

Based in the United States with residence in AZ, FL, GA, or TX, you will conduct internal and external quality audits, help set benchmarks, and work with leadership to implement QA programs, reporting findings to management and ensuring compliance.