At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Manager, Offshore Risk Adjustment
Location
United States
Posted
10 days ago
Salary
$96.1K - $126K / year
No structured requirement data.
Job Description
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: Dallas, TX. 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
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.
Related Guides
Related Categories
Related Job Pages
More Risk Jobs
Manager, Offshore Risk Adjustment
Oscar HealthAt Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
This role involves managing offshore coding teams to ensure the accurate and timely delivery of coding services, including daily operations oversight, performance management, and quality assurance. The manager will also collaborate with onshore/offshore stakeholders to meet service, compliance, and performance goals.
Technology Risk Analyst
Walker & DunlopWe create communities – with ideas and capital – where people live, work, shop, and play.
Technology Risk Analyst operationalizing risk assessments and compliance insights at Walker & Dunlop
Risk Adjustment Representative conducting medical record audits and ensuring coding accuracy
Data Governance Lead
JobgetherWe use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
In this pivotal role, you will lead the enterprise-wide shift toward managing data as a strategic product, defining clear ownership, scalable governance frameworks, and actionable processes. You will design and implement domain-based governance models, enabling trusted, compliant...
