Hi, we're Oscar. We're hiring a Manager, Risk Adjustment to join our Risk Adjustment team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role
The Manager, Risk Adjustment monitors performance standards, implementing workflows, supporting strategic vision, and administering all aspects of Risk Adjustment Coding and Auditing Programs to meet our needs of Oscar and the requirements of our regulatory agencies.
You will report to the Senior Manager, Risk Adjustment Coding Accuracy and Auditing.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
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
Qualifications
- 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)
Bonus Points
- 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
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.
What We Do
Healthcare is broken; we're trying to fix it. The Oscar team is focused on utilizing technology, design and data to humanize healthcare. We're a group of technology and healthcare professionals who looked at the current state of the US healthcare system, got frustrated by the horrible consumer experience, and decided to do something big about it.
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