Hi, we're Oscar. Were hiring a Risk Adjustment Manager to join our Risk Adjustment 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:
Effectively manage & direct the In Home Assessment Program, Point of Care Programs, Auditing Program, & Risk Adjustment department to meet the needs of its internal customers & the requirements of our regulatory agencies. The individual will provide leadership & management skills to achieve efficiencies & contribute to creating an insurer of choice for current/prospective customers & a workplace of choice for associates. Success will be based on the individual's professional ability to lead a team toward a common goal, effectively communicate & manage complex regulatory issues creating competitive value in the marketplace & plan activities.
You will report into the Director, Revenue Operations.
- Responsible for State & Federal regulatory activities working to promote & ensure Risk Adjustment activities are compliant with all applicable laws, regulations, rules & policies.
- Conduct special studies/projects & identify opportunities for operational improvements consistent with Oscars strategic goals.
- Manages the In Home Assessment Program to meet business objectives, CMS regulations & quality standards for Medicare Advantage & ACA Risk Adjustment, including provider education, coding, auditing & referrals along with the daily operations of the Risk Adjustment coders & auditors
- Manages the development of provider audit processes to meet & maintain regulatory/accreditation/operational requirements, including reporting a detailed analysis of the issue, making recommendations & following the outcome.
- Manages the internal audit processes to ensure that the Risk Adjustment record review team & Auditors meet & maintain departmental quality standards & that data submitted as a result of these reviews is thorough & accurate.
- Manages the development & oversight of Point of Care Programs in order to provide complete & accurate Risk Adjustment & HEDIS data on behalf of membership to regulatory agencies.
- Accountable for creating a culture of compliance with Oscars core values, policies & procedures & applicable regulatory requirements & standards.
- Develops & makes decisions regarding appropriate forecasting methods & tools for financial reporting. Design, prepare & produce reports related to the In Home Assessment Program, Point of Care Programs & Risk Adjustment Coding at the plan level & driving an overall management process to analyze the expected impact on revenue.
- Responsible for coaching & development of a team.
- Bachelors degree in relevant field of study or 5+ years of related work experience
- Certified Professional Coder (CPC)
- Subject matter expert in areas of Medicare & Commercial Risk Adjustment
- Risk Adjustment Data Validation (RADV) experience.
- PAHM or other health related certification (required within first year of employment)
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.
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 (email@example.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.