Hi, we’re Oscar. We’re hiring a Vice President, Risk Adjustment Strategy & Solutions on our Operations team.

About the role

The Vice President of Risk Adjustment Strategy & Solutions will drive the advancement of Oscar’s value capture initiatives for its ACA and MA populations. They will be responsible for strategic planning and program design & optimization, ensuring that Oscar’s risk adjustment programs are efficient, effective, and compliant. This leader will need to collaborate with stakeholders across the enterprise to develop new programs and optimize existing retrospective and prospective risk adjustment initiatives. They will lead a team of individuals with strong analytic and program management skills that are responsible for developing and overseeing the risk adjustment operations budget, planning for major initiatives (e.g. the annual chart retrieval process, RADV, etc), and managing critical partners and vendors. In addition, they will oversee a team of ~40 coders and auditors charged with ensuring the efficacy of our coding efforts and that of our outsourcer.

The Vice President of Risk Adjustment Strategy & Solutions will be responsible for strategic planning and program management of Oscar’s Risk Adjustment initiatives

You will report to the Senior Vice President, Operations.

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 is: $228,000 - $299,250 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants, and annual performance bonuses.

Responsibilities

• Evolve Oscar’s Risk Adjustment program strategy to achieve improved, consistent, and cost effective results, while eliminating sources of risk or performance uncertainty.
• Lead financial planning for all risk adjustment programs and manage to budget.
• Oversee all critical program vendors, including setting the strategy on outsourcing vs. insourcing, assessing new partner opportunities, initiating new relationships, and managing performance of existing partners.
• Drive continuous improvement by monitoring historical and current data trends to steer new program development and optimize performance of existing initiatives.
• Serve as liaison between Product Development, Revenue Operations, P&L/Network and Data Science to ensure the business requirements are heard and actionable.
• Maintain in-depth knowledge of the company’s business and regulatory environments.
• Provide subject matter expertise in the determination of benchmarks, goals, and outcomes for corporate-wide Risk Adjustment initiatives.
• Ensure compliance with all revenant CMS requirements and processes

Qualifications

• Bachelor’s degree or commensurate experience
• 15+ years of experience in health care or managed care
• 10+ years of operational strategy, execution, and P&L management
• 10+ years of experience in Medicare Advantage or ACA products
• 8+ years of experience in risk adjustment
• 10+ years leading and supporting a team
• Financial planning, strategic analysis, and budget management experience
• Operational experience building and designing new programs

Bonus Points

• Masters degree in Business, Finance, or Healthcare related field
• Certified risk adjustment coder