Manager, Offshore Risk Adjustment

Hi, we're Oscar. We're hiring a Manager, Offshore Risk Adjustment to join our Value Capture team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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, Offshore Risk Adjustment manages off-shore coding teams to ensure accurate, and timely delivery of coding services. You will include daily operations oversight, performance management, quality assurance, and collaborations with onshore/offshore stakeholders to meet service goals, compliance standards, and performance goals.

You will report into the Associate Director, Risk Adjustment.

Work Location

This position is based in our Tempe, AZ office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.

Pay Transparency

The base pay for this role is: $96,130 - $126,171 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

Manage onboarding of offshore coding teams, including IT setup, contingent worker administration, training, and ongoing development.

Monitor overall offshore team performance, assessing project production, coding quality, and pace following industry standards, regulatory deadlines, and business objectives.

Oversee the management, project volume pacing plans, and quality scoring reporting for offshore risk adjustment activities.

Be the primary liaison, facilitating communication between offshore teams and onshore leadership.

Evaluate a variety of medical records and provider documentation to ensure the validity and accuracy of ICD-10-CM codes; create and conduct routine quality audits and pacing plans for weekly presentation.

Review Service Level Agreement (SLA) performance; timely address and identify coding trends to leadership, promote resolution and implement necessary changes.

Develop standard operating procedures, workflows, and best practices.

Ensure team performance and accuracy follow State and Federal regulatory guidance, guaranteeing that all Risk Adjustment activities comply with applicable laws, regulations, rules, and policies.

Support and facilitate change management programs, including the implementation of new tools, systems, or coding guidelines.

Compliance with all applicable laws and regulations

Other duties as assigned

Requirements

Bachelor's degree in a relevant field of study or commensurate work experience

5+ Years of experience in RA Coding and Auditing

3+ Years experience as the subject matter expert in areas of Medicare Advantage and Commercial (ACA) Risk Adjustment

1+ year of training or mentoring RA Coder/Auditor

2+ Years Experience with Electronic Health Records (EHRs) and Clinical Continuity of Care Documents (CCDs)

Certified Professional Coder (CPC)

Excellent communication and stakeholder management skills

Strong analytical, problem solving, and organizational skills

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) Experience

Clinical Documentation Improvement (CDI) Education / Provider Education Feedback

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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.

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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.

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