Risk Adjustment Coder Specialist

About the Role

The Risk Adjustment Coder Specialist role is a key component of Oscar Health's efforts to provide high-quality, patient-centered care. As a member of the risk adjustment team, you will be responsible for reviewing medical records, assigning ICD-10-CM diagnosis codes, and ensuring that coding practices are accurate and compliant with industry standards. Your work will have a direct impact on the company's ability to provide excellent care to its members.

Oscar Health is committed to fostering a culture of innovation and collaboration. As a remote employee, you will be part of a dynamic team that values flexibility, creativity, and open communication. With a strong focus on employee development and growth, Oscar Health offers a supportive environment that encourages professional growth and advancement.

What You Will Do

• Review medical records to assign ICD-10-CM diagnosis codes for ACA and MA lines of business
• Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines
• Participate in CMS audits of Risk Adjustment activities, including Risk Adjustment Data Validation audits
• Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process
• Support the identification of document improvement opportunities for provider education in both MA and ACA lines of business
• Identify process improvements to enhance medical encounter review efficiency
• Collaborate with the management team to establish effective risk adjustment processes
• Ensure compliance with all applicable laws and regulations
• Participate in training and development opportunities to stay current with industry developments and regulatory changes
• Analyze data to identify trends and areas for improvement in risk adjustment coding practices

What We Are Looking For

• Bachelor's degree in a relevant field of study or commensurate work experience
• Certified Professional Coder (CPC) certification
• 2+ years of retrospective risk adjustment coding experience
• Strong knowledge of ICD-10-CM coding guidelines and regulations
• Excellent analytical and problem-solving skills
• Ability to work collaboratively in a remote team environment
• Strong communication and interpersonal skills
• Experience with Electronic Medical Record (EMR) systems
• Certified Risk Adjustment Coder (CRC) or similar certification (preferred)

Nice to Have

• Experience coding in a variety of different Electronic Medical Record (EMR) systems
• Knowledge of Medicare Advantage and Affordable Care Act regulations
• Experience with data analysis and reporting
• Certification in a related field, such as medical coding or health information management

Benefits and Perks

• Competitive salary
• Comprehensive benefits package, including medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements
• Opportunities for professional growth and development
• Remote work environment with flexible scheduling
• Access to cutting-edge technology and tools
• Collaborative and dynamic team environment

• Make sure to highlight your experience with ICD-10-CM coding guidelines and regulations in your resume and cover letter.
• Be prepared to discuss your experience with risk adjustment coding and your understanding of the risk adjustment process.
• Familiarize yourself with Oscar Health's company culture and values to demonstrate your enthusiasm for the role and the company.
• Consider obtaining a Certified Risk Adjustment Coder (CRC) or similar certification to increase your chances of being hired.
• Be prepared to provide examples of your analytical and problem-solving skills, as well as your ability to work collaboratively in a remote team environment.
• Research the company's benefits and perks to understand the total compensation package and what to expect from the role.
• Practice your coding skills and be prepared to complete a coding test or assessment as part of the interview process.