Oscar Health · 4 hours ago

Senior Specialist, Risk Adjustment Coder

United States

Full-time

Remote

Mid, Senior Level

$73K/yr - $96K/yr

2+ years exp

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Responsibilities

Responsible for daily operations about Risk Adjustment including: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential CMS audits and medical record retrieval efforts.

Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and compliance with Risk adjustment production standards.

Participate in CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.

Develop relationships with main individuals to foster an increased understanding of the Risk Adjustment process.

Support in the identification of document improvement opportunities for provider education in both MA and ACA line of business.

Identify process improvements to enhance medical encounter review efficiency.

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.

Certified Professional Coder (CPC)Risk Adjustment CodingCertified Risk Adjustment Coder (CRC)Electronic Medical Record (EMR) systemsMedical record reviewsICD-10-CM codingCompliance with coding guidelinesProcess improvement