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Oscar Health // health insurance
 
Remote    Posted: Wednesday, September 01, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Risk Adjustment Auditor 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:

This individual will provide superior customer experience by educating internally & externally of errors & opportunities for improvement discovered during routine auditing. This individual will work closely with Management to implement benchmarks, establish acceptable thresholds, & effective quality assurance programs.

You will report to the Director, Revenue Operations

Responsibilities:

  • Maintain a quality assurance program for data collected by the Risk Adjustment & HEDIS Departments. 
  • Assist with monitoring the performance of the Risk Adjustment & HEDIS Teams & report findings to Senior Leadership in a timely, consistent & effective manner ensuring that appropriate changes are implemented. 
  • Support audit processes ensuring work flows & results are properly documented & maintained. Identify process improvements as needed. 
  • Maintain confidentiality in regard to individual error results. 
  • Assist in the development of an effective training program regarding correct coding techniques & data collection methods.
  • Perform chart reviews as needed. 
  • Participate in CMS audits of our Risk Adjustment activities
  • Act as a Subject Matter Expert on all things related to Risk Adjustment & HEDIS. 
  • Assist with the tracking & reporting of identified compliance questions, issues, audits, & investigations through the use of compliance tracking software. 
  • Utilize the compliance tracking tools, to include the monitoring of data entered into the system to ensure accuracy, developing & maintaining data entry workflows & manuals & providing additional training to users. 
  • Provide feedback & education on coding practices identified during routine audits.
  • Conduct special studies/projects as requested by Senior Management & identify opportunities for operational improvements consistent with Oscars strategic goals. 
  • Assist in the maintenance & creation of policies & procedures relating to the Compliance program at Oscar, & participate in the oversight of all Oscars departmental policies to ensure compliance with established State & Federal regulations. 
  • Ensure data submitted by Risk Adjustment & HEDIS teams is complete, accurate & thorough. 
  • Ensure financial impact to the organization is accurate & mitigate risk of regulatory agency audits by validating data submitted for Risk Adjustment & HEDIS measures.
  • Responsible for daily operations pertaining to the In Home Health Assessment program & vPCP Program 
  • Perform external provider audits pertaining to risk adjustment as well as performing internal audits on Risk Adjustment & HEDIS departments medical record reviews.

Requirements:

  • Bachelors degree in relevant field of study preferred or 3+ years related work experience. 
  • Certified coder with a minimum of 2 year's coding experience. 
  • Expert knowledge of Risk Adjustment and/or HEDIS.

Bonus points:

  • PAHM or other health care related certification preferred. Will be required within 1 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.

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.

COVID-19 vaccine requirements for in-person work: 

To protect the health & safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. 

If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices (either full-time or part-time), employees conducting sales work in the field & employees conducting at-home or in-person visits with members.

 
 
 
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