Risk Adjustment Manager

Summary

Join Oscar's Risk Adjustment team as a Manager, overseeing performance standards, implementing workflows, and administering all aspects of Risk Adjustment Coding and Auditing Programs. You will collaborate with multiple teams, create training materials, and manage project volumes. This role requires evaluating medical records, reviewing project performance, and ensuring compliance with regulations. The position is remote or hybrid, depending on location, and offers a competitive salary and benefits package. You'll report to the Senior Manager, Risk Adjustment Coding Accuracy and Auditing. The ideal candidate possesses a Bachelor's degree, relevant experience in RA Coding and Auditing, and team management experience.

Requirements

• Bachelor’s degree in a relevant field of study or commensurate work experience
• 4+ Years of experience in RA Coding and Auditing
• 2+ Years of experience managing teams
• 2+ Years experience as the subject matter expert in areas of Medicare Advantage and Commercial (ACA) Risk Adjustment
• 2+ Years Experience with Electronic Health Records (EHRs) and Clinical Continuity of Care Documents (CCDs)
• Certified Professional Coder (CPC)

Responsibilities

• Monitor overall team performance; project production, coding quality, and pace of projects observing industry standards, regulatory deadlines, business objectives
• Collaborate and participate with multiple teams throughout the business to improve operations and promote business objectives
• Create and conduct risk adjustment training for new hires and existing direct reports to improve performance, quality, and team efficiency
• Delegation, management, and ownership of risk adjustment project volumes and pace
• Evaluate a variety of medical records and provider documentation to ensure validity and accuracy of ICD-10- CM codes
• Review project performance; identify and escalate coding and platform trends to management, manner to promote resolution and convey education
• Align team performance following State and Federal regulatory guidance to ensure Risk Adjustment activities are compliant with all applicable laws, regulations, rules and policies
• Support coding and auditing teams to meet our goals, CMS regulations and quality standards for Medicare Advantage and ACA Risk Adjustment, including provider education, coding, auditing and referrals along with the daily operations of the Risk Adjustment coders and auditors
• Support the review and delivery of provider audit results with education observing regulatory/accreditation/operational requirements
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• PAHM or other health related certification
• Additional clinical or coding certifications (CPMA, CRC, CCS - P, CCS, RHIA, RHIT)
• Risk Adjustment Data Validation (RADV)
• Clinical Documentation Improvement (CDI) Education / Provider Education Feedback

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