Manager of Risk Adjustment, Coding Accuracy and Auditing

Hi, we're Oscar. We're hiring a Manager of Risk Adjustment to join our Coding Accuracy and Auditing 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

As the Manager of Risk Adjustment Coding Accuracy and Auditing Programs you will effectively manage and direct a team of 25 Coders and 24 Auditors through all aspects of Risk Adjustment Coding and Auditing Programs to meet the business needs of Oscar and the requirements of our regulatory agencies. You will be in charge of ensuring outcomes are met and associates and vendors are maximizing their ability to improve efficiency and increase the quality, completeness and accuracy of our coding and documentation experience. In this role, you will be juggling many demands in a dynamic environment.

You will report to the Senior Director, Risk Adjustment Strategy & Solutions

This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $108,000 - $141,750 per year. The base pay for this role in all other locations is: $97,200 - $127,575 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• People Management
  • Manage the day-to-day success and operations of the team, including KPI results 
  • Identify trends and knowledge gaps across Risk Adjustment Coding/Auditing, utilizing findings to improve training and operational effectiveness
  • Participate in all people-related decisions, including but not limited to, attendance, behavioral coaching conversations, and performance management outcomes
  • Assess and provide ongoing career development for Coding and Auditing staff along with the encouragement of Oscar’s culture to drive employee engagement and satisfaction
  • Connect with People Strategy partners to grow Coding/Auditing teams and ensure proper staffing/ hiring levels for optimal member experience throughout the year
• Business Acumen/Strategic Initiatives
  • Identify continuous improvement opportunities and drive efficiencies as it relates to the coding and auditing process by taking a proactive and forward-thinking approach
  • Measure and track results, make recommendations and improve upon production outcomes and quality delivery  
  • Create timelines that anticipate overall inventory and ensure staffing models are aligned
  • Own, track, and monitor vendor performance on a frequent basis and ensure alignment to SLAs and oOutcomes within a set budget
  • Apply knowledge and skills while utilizing organizational agility within all areas of the business 
  • Partner cross-functionally with various leaders throughout the business to drive operational and quality improvement
• Regulatory and Compliant Practices
  • Responsible for State and Federal regulatory activities working to promote and ensure Risk Adjustment activities are compliant with all applicable laws, regulations, rules and policies.
  • Manages the Coding and Auditing teams to meet business objectives, 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
  • Manages the development of provider audit processes to meet and maintain regulatory/accreditation/operational requirements, including reporting a detailed analysis of the issue, making recommendations and following the outcome.
  • Manages the internal audit processes to ensure that the Risk Adjustment record review team and Auditors meet and maintain departmental quality standards and that data submitted as a result of these reviews is thorough and accurate

Qualifications

• 5+ Years of experience in Coding and Auditing
• 3+ Years of experience managing teams
• Certified Professional Coder (CPC)
• 3+ Years experience as the subject matter expert in areas of Medicare Advantage and Commercial (ACA) Risk Adjustment 
• 3+ Years experience with Risk Adjustment Data Validation (RADV) managing both audit