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Oscar Health // health insurance
 
Orlando, Florida, United States    Posted: Tuesday, March 09, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Risk Adjustment Coder Specialist to join our HEDIS team. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.

About the role:

Risk Adjustment Coder for both Medicare Advantage (MA) & Affordable Care Act (ACA) lines of business.  Works closely with management to meet communicated individual & departmental goals, deadlines set forth by CMS, & be active & engaged in establishing effective Risk Adjustment processes.

You will report into the Director, Revenue Operations.

Responsibilities:

  • Maintain compliance with national standards & coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as 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 key individuals to foster an increased understanding of the Risk Adjustment process. 
  • Plan, coordinate & develop methodologies for monitoring the financial performance of the MA & ACA line of business. 
  • Implement process improvements that will maximize risk adjustment factor increases.
  • Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews, potential CMS audits & medical record retrieval efforts.

Requirements:

  • You have a BA/BS Degree or equivalent experience 
  • 2+ Years coding experience or 1+ years of direct Risk Adjustment, CMS, HCC Model experience
  • Certified Professional Coder
  • Understanding of Federal Medicare program, Medicare Advantage Plans, & the medical insurance industry

Bonus points:

  • Certified Risk Adjustment Coder
  • Professional Academy of Healthcare Management (PAHM)

Life at Oscar: 

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 & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.

We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

 
 
 
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