Risk Adjustment Auditor

🔥 50 minutes ago

🌵 Arizona, Florida, +1 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🤠 Texas – Remote

💵 $82.7k - $108.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Conduct internal and external quality audits of ICD-10 code abstraction for accuracy, completeness, and clinical documentation improvement opportunities • Work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs • Perform medical record reviews and report ICD-10-CM diagnosis codes for ACA and MA lines of business • Support potential CMS and HHS audits and medical record retrieval efforts • Validate that EDGE data is supported within provider encounter documentation • Review Risk Adjustment Coding team performance and report audit trends to Leadership • Maintain compliance with ICD-10-CM coding guidelines and Risk Adjustment production standards • Conduct CMS Risk Adjustment Data Validation audits • Develop relationships to increase understanding of the Risk Adjustment process • Create clinical documentation improvement resources for provider education • Manage process improvements to maximize risk adjustment factor increases • Comply with applicable laws and regulations

🎯 Requirements

• Bachelor's degree in a relevant field of study or commensurate work experience • Certified professional coder (CPC) • 3+ year(s) retrospective risk adjustment coding experience • 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience • Experience coding in a variety of different Electronic Medical Record (EMR) systems is a bonus • Certified Risk Adjustment Coder (CRC) or similar certification is a bonus

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Annual performance bonuses • Medical benefits • Dental benefits • Vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life insurance • Disability insurance • Paid wellness time • Wellness reimbursements • Reasonable accommodations during the application process

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