Remote Risk Adjustment Auditor - Quality & RADV Expert

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

Benefits offered by this job

Unlimited vacation

Performance bonuses

Benefits package

Job summary

Oscar Health is seeking an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. You will conduct ICD-10 code abstraction and quality audits to improve accuracy and identify documentation improvements.

You will report to the Manager, Risk Adjustment. This is a remote position open to several states with occasional travel for meetings and events. Base pay ranges from $82,717 to $108,566 per year, plus benefits and bonuses.

Qualifications

• Bachelor's degree or commensurate work experience.
• Certified professional coder (CPC).
• 3+ years retrospective risk adjustment coding experience.
• 1+ year experience Quality Auditing and/or RADV audit experience.

Responsibilities

• Conduct daily operations for Risk Adjustment including medical record reviews and ICD-10-CM coding.
• Validate EDGE data is supported within provider documentation.
• Monitor audit trends and report to Leadership for corrective actions.
• Maintain compliance with ICD-10-CM guidelines and Risk Adjustment standards.
• Perform CMS RADV audits and related activities.
• Develop relationships to deepen understanding of Risk Adjustment processes.
• Identify resources for provider education in MA and ACA lines of business.
• Support process improvements to maximize risk adjustment factors.
• Comply with applicable laws and regulations.

Skills

ICD-10 coding

Quality auditing

RADV audits

Education

Bachelor's degree

Tools

EDGE data environment

Job description

Oscar Health is seeking an Associate, Risk Adjustment Auditor to join our Risk Adjustment team. You will conduct ICD-10 code abstraction and quality audits to improve accuracy and identify documentation improvements.

You will report to the Manager, Risk Adjustment. This is a remote position open to several states with occasional travel for meetings and events. Base pay ranges from $82,717 to $108,566 per year, plus benefits and bonuses.