Manager, Offshore Risk Adjustment

<p>Hi, we're Oscar. We're hiring a Manager, Offshore Risk Adjustment to join our Value Capture team.</p> <p>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.</p> <p><strong>About the role:</strong></p> <p>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.</p> <p>You will report into the Associate Director, Risk Adjustment.</p> <p><strong>Work Location: </strong>This position is based in our New York City 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. #LI-Hybrid</p> <p><strong>Pay Transparency: </strong>The base pay for this role is: $106,812 - $140,190 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Manage onboarding of offshore coding teams, including IT setup, contingent worker administration, training, and ongoing development.</li> <li>Monitor overall offshore team performance, assessing project production, coding quality, and pace following industry standards, regulatory deadlines, and business objectives.</li> <li>Oversee the management, project volume pacing plans, and quality scoring reporting for offshore risk adjustment activities.</li> <li>Be the primary liaison, facilitating communication between offshore teams and onshore leadership.</li> <li>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.</li> <li>Review Service Level Agreement (SLA) performance; timely address and identify coding trends to leadership, promote resolution and implement necessary changes.</li> <li>Develop standard operating procedures, workflows, and best practices.</li> <li>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.</li> <li>Support and facilitate change management programs, including the implementation of new tools, systems, or coding guidelines.</li> <li>Compliance with all applicable laws and regulations</li> <li>Other duties as assigned</li> </ul> <p><strong>Requirements:</strong></p> <ul> <li>Bachelor's degree in a relevant field of study or commensurate work experience</li> <li>5+ Years of experience in RA Coding and Auditing</li> <li>3+ Years experience as the subject matter expert in areas of Medicare Advantage and Commercial (ACA) Risk Adjustment</li> <li>1+ year of training or mentoring RA Coder/Auditor</li> <li>2+ Years Experience with Electronic Health Records (EHRs) and Clinical Continuity of Care Documents (CCDs)</li> <li>Certified Professional Coder (CPC)</li> <li>Excellent communication and stakeholder management skills</li> <li>Strong analytical, problem solving, and organizational skills</li> </ul> <p><strong>Bonus points:</strong></p> <ul> <li>PAHM or other health related certification</li> <li>Additional clinical or coding certifications (CPMA, CRC, CCS - P, CCS, RHIA, RHIT)</li> <li>Risk Adjustment Data Validation (RADV) Experience</li> <li>Clinical Documentation Improvement (CDI) Education / Provider Education Feedback</li> </ul><div class="content-conclusion"><p><span style="font-weight: 400;">This i ... (truncated, view full listing at source)