Oscar Health
Risk Adjustment Auditor
$83K–$109K
Texas, United States +1 · Full-time · Posted Sep 29, 2026
- Location
- Texas, United States
New York, United States - Experience
- 3+ year(s) retrospective risk adjustment coding experience; 1+ year(s) Quality Auditing and/or RADV experience.
- Education
- Bachelor's degree in a relevant field of study or commensurate work experience.
About the job
Conducts risk adjustment coding audits and medical record reviews to assess ICD-10-CM accuracy, documentation support, and opportunities for improvement.
What you'll do
- Review medical records and report ICD-10-CM diagnosis codes for ACA and MA lines of business; support audit and record-retrieval efforts.
- Conduct quality and CMS risk adjustment audits, validate encounter data against provider documentation, and report coding trends.
- Develop provider education and documentation-improvement resources, and help implement process improvements and quality programs.
What they ask for
- Bachelor's degree in a relevant field of study or commensurate work experience.
- Certified professional coder (CPC).
- 3+ year(s) retrospective risk adjustment coding experience.
- 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience.
Nice to have
- Certified Risk Adjustment Coder (CRC) or similar certification.
- Experience coding in a variety of different Electronic Medical Record (EMR) systems.
Pay
$82,717 - $108,566 per year (base salary)
Tools
ICD-10-CM, EDGE, Electronic Medical Record (EMR) systems
AI focus
The posting references AI Guidelines for acceptable candidate use and explains that AI supports recruiting efforts; the role itself does not state AI duties.
Model-written summary · the original posting is authoritative