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Director, Risk Adjustment Retrospective

Oscar Health

Oscar Health

Remote
Posted on Tuesday, July 9, 2024

Hi, we're Oscar. We're hiring a Director, Risk Adjustment Retrospective to join our Risk Adjustment team.

Oscar is the first health insurance company built around a full stack technology platform and a 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

You will bring the strategy, program design and implementation of the Retrospective Risk Adjustment functions at Oscar. The primary responsibility for this role is to set the strategy and deploy tactics that allow us to enhance our overall program value.

You will report to the Sr. Director, Risk Adjustment Strategy & Solution.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our Tempe office (off the 101 at University Dr), we ask you to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Colorado, Florida, Georgia, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $156,960 - 206,010 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

  • Leadership of all Retrospective Risk Adjustment operations (non-coding)
  • Extremely deep, first-hand experience of the Medical Chart Retrieval Process
  • Set, achieve, and maintain Medical Record Retrieval goals
  • Experience creating and structuring EMR/EHR and Supplemental file processes as relates to Risk Adjustment
  • Manage extremely important and large vendor contracts
  • Understanding of ACA line of business and RADV process
  • Work cohesively with data science/analytics to ensure retrospective activities are optimized
  • Oversee tracking SLAs, and maintaining billing hygiene
  • Proven ability to lead a team
  • Relationship and influencing capabilities with Market Leadership and strategic Provider partnerships
  • Experience with how compliance is linked to Risk Adjustment
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Qualifications

  • 10+ years experience in healthcare strategy and operations, and/or related field
  • 7+ years Risk Adjustment experience
  • 5+ years of management experience
  • 3+ years experience in leading large-scale cross functional programs

Bonus Points

  • Master’s degree
  • Clinical licensure
  • Management Consulting experience with a focus on healthcare
  • Experience modeling in Excel / Google Sheets
  • Experience in a growth-stage company

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.

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 Notice to Job Applicants.