Senior Specialist, Risk Adjustment Coder

Summary

Join Oscar's Risk Adjustment team as a Risk Adjustment Coder Specialist! This role involves medical record reviews, ICD-10-CM coding for Medicare Advantage and ACA lines of business, and participation in CMS audits. You'll work to improve processes and foster understanding of risk adjustment. The position offers a blended work culture with remote options and a competitive salary. Successful candidates will possess a Bachelor's degree or equivalent experience, CPC certification, and 2+ years of relevant coding experience. Additional certifications and EMR system experience are beneficial.

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

• 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