Senior Specialist, Risk Adjustment Coder

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 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

The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work with management to meet communicated single 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 Risk Adjustment processes.

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You will report to the Risk Adjustment Coding Lead.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. 

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.  

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $72,800 - $95,550 a year.  The base pay for this role in all other locations is: $65,520 - $85,995 a year.  You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Responsible for daily operations about Risk Adjustment 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 standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and 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 main 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

Qualifications

• 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 multiple different Electronic Medical Record (EMR) systems.