Job details

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.

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

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.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

Oscar Health Glassdoor Company Review

3.2

Oscar Health DE&I Review

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CEO of Oscar Health

Mark Bertolini

Approve of CEO

Average salary estimate

$108855 / YEARLY (est.)

min

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$88560K

$129150K

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What You Should Know About Manager, Risk Adjustment, Oscar Health

Hey there! We're Oscar, and we are on the lookout for a passionate Manager, Risk Adjustment to join our Risk Adjustment team. At Oscar, we're not just another health insurance company; we believe in leveraging technology to create a health experience like no other for our members. Founded in 2012, our mission is to build a service that feels like a trusted family doctor. As our Manager, Risk Adjustment, your role will be pivotal. You'll be implementing workflows, monitoring team performance, and ensuring that our Risk Adjustment Coding and Auditing Programs are executed flawlessly. Reporting to the Senior Manager, Risk Adjustment Coding Accuracy and Auditing, you'll have the opportunity to collaborate with various teams across the business to enhance operations and drive our strategic vision. We're a blended work culture, welcoming both in-office and fully remote work. If you're within commuting distance of our New York, Tempe, or Los Angeles offices, we value face-to-face time two days a week. If not, you can happily work from home as long as you're situated in one of the approved states. We offer a competitive salary and benefits package, including unlimited vacation—something that truly sets us apart. If you have experience in RA coding and auditing, team leadership, and you're ready to make a real impact in healthcare, we want to hear from you!

Frequently Asked Questions (FAQs) for Manager, Risk Adjustment Role at Oscar Health

What are the responsibilities of the Manager, Risk Adjustment at Oscar?

As the Manager, Risk Adjustment at Oscar, you'll be responsible for monitoring team performance and project production while ensuring compliance with industry standards and regulatory deadlines. You'll collaborate with various teams to enhance operational efficiency and improve project outcomes. Training new hires and existing team members in risk adjustment processes is also part of your role, alongside delegating and managing project volumes.