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 is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

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