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Full-Time

Senior Specialist

Risk Adjustment Coder

Confirmed live in the last 24 hours

Oscar Health

Oscar Health

1,001-5,000 employees

Health insurance provider using technology

Fintech
Social Impact
Healthcare

Compensation Overview

$65.5k - $95.5kAnnually

+ Annual Performance Bonuses

Junior, Mid, Senior

Los Angeles, CA, USA + 3 more

More locations: Remote in USA | Tempe, AZ, USA | New York, NY, USA

Hybrid for candidates near New York City, Tempe, and Los Angeles; remote for all other states.

Category
Healthcare Administration & Support
Medical, Clinical & Veterinary
Requirements
  • Bachelor’s degree in a relevant field of study or commensurate work experience.
  • Certified professional coder (CPC)
  • 2+ year(s) retrospective risk adjustment coding experience.
Responsibilities
  • Responsible for daily operations about Risk Adjustment including: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential CMS audits and medical record retrieval efforts.
  • Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, and compliance with Risk adjustment production standards.
  • Participate in CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
  • Develop relationships with main individuals to foster an increased understanding of the Risk Adjustment process.
  • Support in the identification of document improvement opportunities for provider education in both MA and ACA line of business.
  • Identify process improvements to enhance medical encounter review efficiency.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Oscar Health provides health insurance plans for individuals, families, and small businesses, aiming to simplify the insurance experience through technology. Their services include 24/7 virtual care, allowing members to consult healthcare providers anytime, which is convenient for those needing immediate medical advice. Oscar also offers tools to help members find in-network doctors, hospitals, and pharmacies, enhancing access to care. Unlike many traditional insurers, Oscar focuses on user engagement and digital accessibility, ensuring their services are inclusive for all, including people with disabilities. The company's goal is to make healthcare more accessible and affordable while maintaining high-quality care.

Company Stage

N/A

Total Funding

$1.6B

Headquarters

New York City, New York

Founded

2012

Growth & Insights
Headcount

6 month growth

3%

1 year growth

4%

2 year growth

5%
Simplify Jobs

Simplify's Take

What believers are saying

  • Oscar Health's aim to double its membership by 2027 indicates significant growth potential and market expansion.
  • The company's strong financial performance and profitability outlook for 2024 reflect robust business health.
  • Strategic partnerships, such as the one with Sanford Health Plan, enhance member engagement and technological integration.

What critics are saying

  • The competitive health insurance market requires continuous innovation to maintain a competitive edge.
  • Dependence on ACA policies and government regulations could pose risks if there are changes in healthcare laws.

What makes Oscar Health unique

  • Oscar Health leverages technology to simplify and humanize the insurance experience, setting it apart from traditional insurers.
  • Their 24/7 virtual care services provide immediate medical consultations, enhancing accessibility and convenience for members.
  • Oscar's focus on ACA-compliant plans and transparency in pharmacy benefits positions it uniquely in the market.

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Benefits

Health insurance - That’s a given. Employees and their families receive incredible health insurance.

Financial benefits - A penny saved....we’re talking about a 401K plan, health savings accounts, and more.

Well @ Oscar - We care about your wellness with fitness classes and access to mental health support.

Work-Life Balance - We offer multiple time-off options, wellness days, and 10+ weeks of parental leave.

Learning & Development - We offer everything from mentorship to management training.