Risk Manager • Senior

Who you are

You have a strong background in risk adjustment coding, particularly with Medicare Advantage and Affordable Care Act lines of business. Your experience includes conducting medical record reviews and reporting ICD-10-CM diagnosis codes, ensuring compliance with regulations set forth by the Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS). You are detail-oriented and understand the importance of maintaining accurate records for potential audits.

You thrive in a collaborative environment, working closely with management to meet departmental goals and deadlines. Your ability to communicate effectively with team members and stakeholders is essential in establishing effective Risk Adjustment processes. You are proactive in identifying areas for improvement and implementing solutions that enhance operational efficiency.

What you'll do

As a Risk Adjustment Coder Specialist at Oscar, you will be responsible for the daily operations related to Risk Adjustment. This includes conducting thorough medical record reviews to report accurate ICD-10-CM diagnosis codes for both Medicare Advantage and ACA lines of business. You will also play a key role in preparing for potential CMS audits and managing medical record retrieval efforts. Your attention to detail will ensure compliance with national standards and regulations.

You will report directly to the Manager of Risk Adjustment and will be actively engaged in establishing effective processes that align with the company's goals. Your role may require occasional travel for team meetings and company events, although the majority of your work will be conducted remotely from your home office. You will also have the opportunity to participate in Oscar's unlimited vacation program and annual performance bonuses, contributing to a supportive work-life balance.

What we offer

Oscar provides a competitive salary range of $67,813 - $89,004 per year, along with comprehensive employee benefits. You will be part of a company that values innovation and a member-focused approach to health insurance. The culture at Oscar encourages collaboration and continuous improvement, making it an exciting place to grow your career in risk adjustment coding.