Manager, Offshore Risk Adjustment
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: Dallas, TX. 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
Benefits
- employee benefits
- participation in Oscar's unlimited vacation program
- annual performance bonuses
- medical, dental, and vision benefits
- 11 paid holidays
- paid sick time
- paid parental leave
- 401(k) plan participation
- life and disability insurance
- paid wellness time and reimbursements
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What This Job Offers
Job Type
Full-time
Career Level
Manager
