Risk Adjustment Coder Specialist

Oscar Health; Remote; USD 67,000 - 90,000; Full time

Job summary

A leading health insurance company is looking for a Senior Specialist in Risk Adjustment for their Medicare Advantage and ACA lines. This remote position requires expertise in ICD-10-CM coding and risk adjustment processes, ideally with a bachelor's degree and CPC certification. The role involves daily operations, compliance with CMS standards, and participation in audits. Candidates should bring at least 2 years of experience in risk adjustment coding and be ready to enhance operational efficiencies within the team.

Benefits

Unlimited vacation program

Annual performance bonuses

Qualifications

• Bachelor's degree in a relevant field of study or commensurate work experience.
• Certified professional coder (CPC).
• 2+ years retrospective risk adjustment coding experience.

Responsibilities

• Responsible for daily operations pertaining to Risk Adjustment including medical record reviews.
• Maintain compliance with national standards and coding practices.
• Participate in CMS audits of Risk Adjustment activities.
• Develop relationships for better understanding of Risk Adjustment process.
• Identify process improvements for medical encounter review efficiency.

Skills

Risk Adjustment Compliance

Medical Record Review

ICD-10-CM Coding

Interpersonal Skills

Education

Bachelor's degree in relevant field

Certified professional coder (CPC)

Tools

Electronic Medical Record (EMR) systems

Job description

About the role

The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes.

Work Location

This is a remote position, open to candidates who reside in Arizona, Florida, Georgia, or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency

The base pay for this role is $67,813 – $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Responsible for daily operations pertaining to Risk Adjustment including but not limited to medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential CMS audits, and medical record retrieval efforts.
• Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
• Participate in CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
• Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
• Support in the identification of document improvement opportunities for provider education in both MA and ACA line of business.
• Identify process improvements to enhance medical encounter review efficiency.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Requirements

• Bachelor's degree in a relevant field of study or commensurate work experience.
• Certified professional coder (CPC).
• 2+ years retrospective risk adjustment coding experience.

Bonus points

• Certified Risk Adjustment Coder (CRC) or similar certification.
• Experience coding in a variety of different Electronic Medical Record (EMR) systems.

Equal Opportunity

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Reasonable Accommodation

Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.