Manager, Risk Adjustment

Hi, we're Oscar. We're hiring a Manager, Risk Adjustment to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

The Manager, Risk Adjustment monitors performance standards, implementing workflows, supporting strategic vision, and administering all aspects of Risk Adjustment Coding and Auditing Programs to meet our needs of Oscar and the requirements of our regulatory agencies.

You will report to the Senior Manager, Risk Adjustment Coding Accuracy and Auditing.

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Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Monitor overall team performance; project production, coding quality, and pace of projects observing industry standards, regulatory deadlines, business objectives. 
• Collaborate and participate with multiple teams throughout the business to improve operations and promote business objectives. 
• Create and conduct risk adjustment training for new hires and existing direct reports to improve performance, quality, and team efficiency 
• Delegation, management, and ownership of risk adjustment project volumes and pace
• Evaluate a variety of medical records and provider documentation to ensure validity and accuracy of ICD-10- CM codes. 
• Review project performance; identify and escalate coding and platform trends to management, manner to promote resolution and convey education. 
• Align team performance following State and Federal regulatory guidance to ensure Risk Adjustment activities are compliant with all applicable laws, regulations, rules and policies.
• Support coding and auditing teams to meet our goals, CMS regulations and quality standards for Medicare Advantage and ACA Risk Adjustment, including provider education, coding, auditing and referrals along with the daily operations of the Risk Adjustment coders and auditors
• Support the review and delivery of provider audit results with education observing regulatory/accreditation/operational requirements.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• Bachelor’s degree in a relevant field of study or commensurate work experience
• 4+ Years of experience in RA Coding and Auditing
• 2+ Years of experience managing teams
• 2+ Years experience as the subject matter expert in areas of Medicare Advantage and Commercial (ACA) Risk Adjustment 
• 2+ Years Experience with Electronic Health Records (EHRs) and Clinical Continuity of Care Documents (CCDs)
• Certified Professional Coder (CPC)

Bonus Points

• PAHM or other health related certification
• Additional clinical or coding certifications (CPMA, CRC, CCS - P, CCS, RHIA, RHIT) 
• Risk Adjustment Data Validation (RADV)
• Clinical Documentation Improvement (CDI) Education / Provider Education Feedback