Oscar Health · 20 hours ago

Manager, Risk Adjustment

United States

Full-time

Remote

Mid, Senior Level

$98K/yr - $129K/yr

4+ years exp

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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

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Risk Adjustment CodingAuditing ProgramsMedicare AdvantageCertified Professional CoderElectronic Health RecordsClinical Continuity of Care DocumentsTeam ManagementRisk Adjustment Data ValidationClinical Documentation ImprovementProvider Education FeedbackPAHM CertificationAdditional Coding Certifications