Associate Risk Adjustment Auditor

Oscar is hiring an Associate, Risk Adjustment Auditor to join its Risk Adjustment team.

Oscar is a health insurance company built on a full-stack technology platform with a focus on serving members. The role supports internal and external quality audits related to ICD-10 code abstraction, accuracy, completeness, and clinical documentation improvement opportunities.

This position reports to the Manager, Risk Adjustment and is remote for candidates residing in Arizona, Florida, Georgia, or Texas. Occasional travel may be required for team meetings and company events.

The base salary range for this role is $82,717 to $108,566 per year. This role is also eligible for employee benefits, unlimited vacation, and annual performance bonuses.

Responsibilities

• Conduct daily Risk Adjustment operations, including medical record reviews to report ICD-10-CM diagnosis codes for ACA and Medicare Advantage lines of business.
• Support CMS, HHS, and RADV audit activities, including medical record retrieval efforts.
• Validate that EDGE data is supported by provider encounter documentation.
• Review Risk Adjustment Coding team performance and report audit trends to leadership.
• Maintain compliance with ICD-10-CM coding guidelines and Risk Adjustment production standards.
• Develop clinical documentation improvement resources for provider education.
• Help implement process improvements that maximize risk adjustment factor increases.
• Perform other duties as assigned.