Risk Adjustment Coder Specialist

Summary

Join Oscar, a health insurance company focused on technology and member service, as a Risk Adjustment Coder Specialist. You will be responsible for medical record reviews, ensuring compliance with coding guidelines, participating in audits, and fostering relationships with key individuals. This role requires a Bachelor's degree, Certified Professional Coder (CPC) certification, and 2+ years of retrospective risk adjustment coding experience. The position offers a competitive salary, benefits including medical, dental, vision, paid time off, parental leave, 401(k), life and disability insurance, and wellness programs. This is a blended work culture with remote options available in select states.

Requirements

• 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

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

Preferred Qualifications

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

Benefits

• 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