Manager, Offshore Risk Adjustment

Oscar Health•Atlanta, GA

17h•Remote

About The Position

The Manager, Offshore Risk Adjustment manages off-shore coding teams to ensure accurate, and timely delivery of coding services. You will include daily operations oversight, performance management, quality assurance, and collaborations with onshore/offshore stakeholders to meet service goals, compliance standards, and performance goals. You will report into the Associate Director, Risk Adjustment. Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Requirements

Bachelor's degree in a relevant field of study or commensurate work experience
5+ Years of experience in RA Coding and Auditing
3+ Years experience as the subject matter expert in areas of Medicare Advantage and Commercial (ACA) Risk Adjustment
1+ year of training or mentoring RA Coder/Auditor
2+ Years Experience with Electronic Health Records (EHRs) and Clinical Continuity of Care Documents (CCDs)
Certified Professional Coder (CPC)
Excellent communication and stakeholder management skills
Strong analytical, problem solving, and organizational skills

Nice To Haves

PAHM or other health related certification
Additional clinical or coding certifications (CPMA, CRC, CCS - P, CCS, RHIA, RHIT)
Risk Adjustment Data Validation (RADV) Experience
Clinical Documentation Improvement (CDI) Education / Provider Education Feedback

Responsibilities

Manage onboarding of offshore coding teams, including IT setup, contingent worker administration, training, and ongoing development.
Monitor overall offshore team performance, assessing project production, coding quality, and pace following industry standards, regulatory deadlines, and business objectives.
Oversee the management, project volume pacing plans, and quality scoring reporting for offshore risk adjustment activities.
Be the primary liaison, facilitating communication between offshore teams and onshore leadership.
Evaluate a variety of medical records and provider documentation to ensure the validity and accuracy of ICD-10-CM codes; create and conduct routine quality audits and pacing plans for weekly presentation.
Review Service Level Agreement (SLA) performance; timely address and identify coding trends to leadership, promote resolution and implement necessary changes.
Develop standard operating procedures, workflows, and best practices.
Ensure team performance and accuracy follow State and Federal regulatory guidance, guaranteeing that all Risk Adjustment activities comply with applicable laws, regulations, rules, and policies.
Support and facilitate change management programs, including the implementation of new tools, systems, or coding guidelines.
Compliance with all applicable laws and regulations
Other duties as assigned