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 have a proven track record of meeting departmental goals and deadlines.

You thrive in a collaborative environment, working closely with management and other team members to establish effective risk adjustment processes. Your communication skills allow you to engage effectively with various stakeholders, and you are comfortable navigating the complexities of healthcare regulations. You are proactive in identifying potential audits and retrieval efforts, ensuring that all operations run smoothly.

What you'll do

As a Risk Adjustment Coder Specialist at Oscar, you will be responsible for the daily operations related to risk adjustment coding. This includes conducting thorough medical record reviews to accurately report ICD-10-CM diagnosis codes for both Medicare Advantage and Affordable Care Act lines of business. You will play a key role in maintaining compliance with national standards and preparing for potential CMS audits.

You will work closely with management to meet communicated individual and departmental goals, ensuring that all deadlines set forth by CMS and HHS are met. Your role will also involve engaging in the establishment of effective risk adjustment processes, contributing to the overall success of the department. While this is a remote position, occasional travel may be required for team meetings and company events.

What we offer

Oscar offers a competitive salary range of $67,813 - $89,004 per year, along with employee benefits and participation in an unlimited vacation program. You will have the opportunity to work in a supportive environment that values your contributions and encourages professional growth. Join us in our mission to create a health insurance company that truly serves its members, and be part of a team that is dedicated to making a difference in the healthcare industry.