Risk Adjustment Coder Specialist

United States·Atlantamid

OtherRisk

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Quick Summary

Key Responsibilities

Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business,

Requirements Summary

Bachelor's degree in a relevant field of study or commensurate work experience. Certified professional coder (CPC) 2+ year(s) retrospective risk adjustment coding experience.

Technical Tools

OtherRisk

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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

~1 min read

The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes.

You will report into the Manager, Risk Adjustment.

Responsibilities

~1 min read

→Responsible for daily operations pertaining to Risk Adjustment including but not limited to: 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, as well as 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 key 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

Requirements

~1 min read

Bachelor's degree in a relevant field of study or commensurate work experience.
Certified professional coder (CPC)
2+ year(s) retrospective risk adjustment coding experience.

Nice to Have

~2 min read

Certified Risk Adjustment Coder (CRC) or similar certification
Experience coding in a variety of different Electronic Medical Record (EMR) systems.

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Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

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