Risk Adjustment Coder, Specialist

Oscar Health

. Perform daily Risk Adjustment operations, including medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business .

Posted 11/4/2026full-timeRemote • United StatesJuniorMid-Level💰 $67,813 - $89,005 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Risk Adjustment operations, including ICD-10-CM coding and compliance with national standards. Proven ability to enhance medical encounter review efficiency and support CMS audits while fostering relationships for provider education.

Highest-signal resume keywords

ICD-10-CM CodingRisk Adjustment OperationsCertified Professional Coder (CPC)Medical Record ReviewElectronic Medical Record (EMR) Systems

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Risk Adjustment CodingICD-10-CM Diagnosis CodesMedical Record RetrievalCoding Guidelines ComplianceData Validation AuditsProcess ImprovementDocument Improvement IdentificationRetrospective Coding ExperienceProvider EducationCompliance with Laws and Regulations

Soft Skills

Relationship BuildingCommunication

Certifications & Qualifications

Certified Professional Coder (CPC)Certified Risk Coder (CRC)

Industry Keywords

CMS AuditsACAMARisk Adjustment StandardsNational Standards

About the role

Key responsibilities & impact

Perform daily Risk Adjustment operations, including medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business
Support potential CMS audits and medical record retrieval efforts
Maintain compliance with ICD-10-CM coding guidelines, national standards, coding practices, and Risk Adjustment production standards
Participate in CMS Risk Adjustment audits, including Risk Adjustment Data Validation audits
Develop relationships with key individuals to increase understanding of the Risk Adjustment process
Support identification of document improvement opportunities for provider education across MA and ACA lines of business
Identify process improvements to enhance medical encounter review efficiency
Comply with all applicable laws and regulations
Perform other duties as assigned
Report to the Manager, Risk Adjustment

Requirements

What you’ll need

Bachelor's degree in a relevant field of study or commensurate work experience
Certified professional coder (CPC)
2+ year(s) retrospective risk adjustment coding experience
CRC or similar certification is a bonus
Experience coding in a variety of different Electronic Medical Record (EMR) systems is a bonus

Benefits

Comp & perks

Employee benefits
Unlimited vacation program
Annual performance bonuses
Medical benefits
Dental benefits
Vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life insurance
Disability insurance
Paid wellness time and reimbursements
Occasional travel for team meetings and company events