[Hiring] Specialist, Risk Adjustment @Oscar Health

Role Description

The Specialist, Risk Adjustment for the Affordable Care Act (ACA) line of business supports the Risk Adjustment team and management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes. You will provide support to our daily operations and deliverables related to our Retrospective and/or Prospective Risk Adjustment Programs.

You will report into the Manager, Risk Adjustment Retrospective.

Work Location:

• This is a remote position, open to candidates who reside in: Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia.
• 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.

Pay Transparency:

• The base pay for this role in the states of New Jersey and New York is: $29.86 - $39.19 per hour.
• The base pay for this role in all other locations is: $26.87 - $35.27 per hour.
• You are also eligible for employee benefits, monthly vacation accrual at a rate of 15 days per year.

Responsibilities

• Support daily operations pertaining to Risk Adjustment including but not limited to: medical record retrieval, provider outreach, researching contact information, creating provider level reports and presentations.
• Maintain a grasp of our medical records inventory and deliverables to ensure we are keeping/exceed pace against goal.
• Make outreach to internal and external partners to improve our ability to hit retrieval goals.
• Represent Risk Adjustment to our internal and external partners and help influence positive outcomes.
• Support team with monitoring, tracking, and statusing our inventory.
• Develop an in-depth understanding of day-to-day workflows at Oscar.
• Become acquainted with internal tools and technical processes, and highlight areas of opportunity for improvement.
• Support your manager by guiding decisions on an ongoing basis.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Qualifications

• Bachelor's degree in a relevant field of study or commensurate work experience.
• 1+ years experience in chart retrieval or provider outreach.
• 1+ years of experience in Healthcare Operations.
• 2+ years of experience with being held to and accomplishing goals.

Requirements

• 1+ years of experience in risk adjustment (bonus points).

Benefits

• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.