Risk Adjustment Coder Specialist

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

Job summary

A health insurance company seeks a Risk Adjustment Coder Specialist for a remote position focusing on Medicare Advantage and ACA lines of business. The role includes conducting medical record reviews and ensuring compliance with coding standards. Candidates must have a Bachelor's degree or equivalent experience, a CPC certification, and at least 2 years of relevant experience. Benefits include competitive salary, unlimited vacation, and various health benefits.

Benefits

Unlimited vacation

Annual performance bonuses

Medical, dental, and vision benefits

401(k) participation

Paid parental leave

Paid wellness time and reimbursements

Paid sick time

Qualifications

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

Responsibilities

• Conduct medical record reviews for reporting ICD-10-CM diagnosis codes.
• Maintain compliance with coding practices and national standards.
• Participate in CMS audits of Risk Adjustment activities.
• Develop relationships to enhance understanding of Risk Adjustment processes.
• Support identification of document improvement opportunities.

Skills

Retrospective risk adjustment coding

ICD-10-CM coding guidelines

Compliance with regulations

Education

Bachelor's degree or equivalent work experience

Certified professional coder (CPC)

Tools

Electronic Medical Record (EMR) systems

Job description

Overview

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About The Role

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. You will report into the Manager, Risk Adjustment.

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+ year(s) 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.

This is an authentic Oscar Health job 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.

Pay Transparency (Additional Info)

Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

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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.

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