Risk Adjustment Coder Specialist Value Capture

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.

You will report into the Manager, Risk Adjustment.

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.

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.

• 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.

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

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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.

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.