Risk Adjustment Coder Specialist

Oscar Health • New York, NY

2d • $67,813 - $98,894 • Remote

About The Position

Oscar is hiring a Risk Adjustment Coder Specialist for its Risk Adjustment team. The Senior Specialist, Risk Adjustment supports Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business, working with management to meet individual and departmental goals and deadlines established by the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS). The role also contributes to establishing effective Risk Adjustment processes.

This position reports to the Manager, Risk Adjustment. It is fully remote for candidates residing in eligible U.S. locations, with daily work performed from a home office and occasional travel for team meetings and company events. Travel of up to 5% is required.

The listed annual base pay is $75,348–$98,894 in California, Connecticut, New Jersey, New York, and Washington, and $67,813–$89,005 in other locations. Final offers within the applicable range depend on relevant skills, education, and experience. Full-time employees are eligible for benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Requirements

• Bachelor's degree in a relevant field of study or commensurate work experience.
• Certified Professional Coder (CPC) credential.
• At least 2 years of retrospective risk adjustment coding experience.

Nice To Haves

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

Responsibilities

• Handle daily Risk Adjustment operations, including 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 ICD-10-CM coding guidelines and Risk Adjustment production standards.
• Participate in CMS audits of Risk Adjustment activities, including Risk Adjustment Data Validation audits.
• Develop relationships with key individuals to foster greater understanding of the Risk Adjustment process.
• Support identification of documentation improvement opportunities for provider education in MA and ACA lines of business.
• Identify process improvements to increase medical encounter review efficiency.
• Comply with all applicable laws and regulations.
• Perform other duties as assigned.

Benefits

• Unlimited vacation program
• Annual performance bonuses
• Medical benefits
• Dental benefits
• Vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life insurance
• Disability insurance
• Paid wellness time and reimbursements

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level