Oscar Health
Risk Adjustment Auditor
$83K–$109K
Georgia, United States +1 · Full-time · Posted Sep 29, 2026
- Location
- Georgia, United States
New York, United States - Experience
- 3+ year(s) retrospective risk adjustment coding experience; 1+ year(s) experience Quality Auditing and/or RADV audit experience.
- Education
- Bachelor's degree in a relevant field of study or commensurate work experience.
About the job
Conducts risk adjustment coding quality audits, validates medical record documentation, and identifies coding and clinical documentation improvement opportunities.
What you'll do
- Review medical records and report ICD-10-CM diagnosis codes for ACA and MA lines of business; support CMS/HHS audits and record retrieval.
- Audit coding team performance, report trends, and help implement quality benchmarks, education, and process improvements.
- Conduct CMS risk adjustment audits, including RADV audits, and develop clinical documentation improvement resources for providers.
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
Model-written summary · the original posting is authoritative