Analyst, Risk Adjustment

Analyst, Risk Adjustment

Hi, we're Oscar. We’re hiring a Senior Retroactive Analyst to join our Risk Adjustment 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:

This position will support quality initiatives for ACA QRS and MA STARS, working closely with internal and external partners to drive improvement across all measures through a project based approach.

You will report into the Vice President, Value Capture. This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change. #LI-Remote

Responsibilities:

  • Project manage the Value Capture chart collection campaign for our ACA and MA populations: 
    • Create and own chart chase list with deep dive into claims and provider data sets
    • Triage chart retrieval issues from vendors and build tools/workflows to assist in obtaining charts. This shall be maintained in periscope and be made available for P&L as well as Actuary and Finance.
    • Produce and organize coding results files for internal coding team to audit
    • Ensure that the collection of charts are being stored and can be retrieved and sent to various stakeholders
    • Integration of Quality chases into risk adjustment infrastructure
  • Manage the RADV member chase and overall chart chase: 
    • Provide all member level reports and screenshots to auditor 
    • Integrate all auditor reporting into periscope and triage chart chase priorities with chart chase vendors and internally for coding review. Reviewing reports for accuracy and surfacing risks during regularly scheduled meetings.
    • Initiate mail merges and ensure seamless movement of medical records (ie. retrieval, storage, and submission)
  • Assist on an ongoing basis, the development of policies and procedures for Risk Adjustment programs under the Affordable Care Act and Medicare.
  • Think creatively about what’s possible for Risk Adjustment programs and Oscar’s Risk Adjustment tools/infrastructure.
  • Provide HEDIS/Quality operational and reporting support by assisting with Chase list generation, chart collection, and escalating risks.
  • Support the MA Risk Adjustment Submissions including RAPS and EDS
  • Responsible for ensuring that vendor files for Value Capture and other associated workstreams are ingested into tables for use by multidisciplinary teams including but not limited to Data Science, Actuary, Finance and P&L.

Requirements:

  • Bachelor’s degree or 4+ years of commensurate experience 
  • Proficient in SQL, Python, or another scripting language
  • 3+ years of SQL Experience
  • 3+ years of healthcare experience in a Risk Adjustment / Ops capacity
  • Understand data, spreadsheets and tables

Bonus points:

  • Master's degree or 6+ years commensurate experience
  • Expert knowledge of Risk Adjustment models and provider data 
  • Relevant experience in leadership

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here

Life at Oscar: 

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.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

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.

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.

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