Specialist, Risk Adjustment

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Quick Summary

Key Responsibilities

Support daily operations pertaining to Risk Adjustment including but not limited to: medical record retrieval, provider outreach, researching contact information,

Requirements Summary

Bachelor's degree in a relevant field of study or commensurate work experience.

Technical Tools

OtherRisk

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

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 Specialist, Risk Adjustment for the Affordable Care Act (ACA) line of business supports the Risk Adjustment team and 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 provide support to our daily operations and deliverables related to our Retrospective and/or Prospective Risk Adjustment Programs.

You will report into the Manager, Risk Adjustment Retrospective.

Responsibilities

~1 min read

→Support daily operations pertaining to Risk Adjustment including but not limited to: medical record retrieval, provider outreach, researching contact information, creating provider level reports and presentations.
→Maintain a grasp of our medical records inventory and deliverables to ensure we are keeping/exceed pace against goal
→Make outreach to internal and external partners to improve our ability to hit retrieval goals
→Represent Risk Adjustment to our internal and external partners and help influence positive outcomes
→Support team with monitoring, tracking, and statusing our inventory
→Develop an in-depth understanding of day-to-day workflows at Oscar
→Become acquainted with internal tools and technical processes, and highlight areas of opportunity for improvement
→Support your manager by guiding decisions on an ongoing basis
→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.
1+ years experience in chart retrieval or provider outreach
1+ years of experience in Healthcare Operations
2+ years of experience with being held to and accomplishing goals

Nice to Have

~2 min read

1+ years of experience in risk adjustment

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

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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