Risk Adjustment Auditor

Job overview

The Risk Adjustment Auditor role is remote for candidates residing in Arizona, Florida, Georgia, or Texas. Base pay is $82,717–$108,566 per year. Oscar Health’s Risk Adjustment team supports its health insurance members and risk adjustment operations. The role conducts quality audits of ICD-10-CM coding and medical records, identifies documentation improvement opportunities, and reports audit trends. It helps maintain coding accuracy and compliance while supporting improvements to risk adjustment processes.

What you'll do

• Conduct medical record reviews and internal and external quality audits of ICD-10-CM diagnosis coding
• validate that EDGE data is supported by provider documentation
• report audit trends
• maintain compliance with coding guidelines and production standards
• conduct CMS risk adjustment audits
• develop provider education resources and process improvements.

What we're looking for

Skills & competencies

risk adjustment auditor

oscar health

remote

arizona

florida

georgia

texas

icd-10-cm

medical record audits

cpc

risk adjustment coding

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision benefits
• 11 paid holidays
• paid sick time
• paid parental leave
• 401(k)
• life and disability insurance
• paid wellness time and reimbursements
• unlimited vacation program
• annual performance bonuses.

Why this role

Remote within Arizona, Florida, Georgia, or Texas; occasional travel may be required. CPC certification and retrospective risk adjustment coding experience are required.

About the employer

Oscar Health is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.