Oscar Health: Risk Adjustment Auditor — Georgia, United States

About Oscar Health

Oscar Health is a health-insurance business built around a technology platform and member services. Its recruitment board also describes Oscar Medical Group activities in virtual health assessments and virtual care. Those notices reflect distinct parts of the wider operation: insurance products and member administration alongside clinical services. Technology, insurance operations and care delivery consequently appear in different roles on the board, with the employing team determining the service and professional responsibilities of an individual position.

The position and its setting

Oscar Health lists Risk Adjustment Auditor in Georgia, United States, under reference 8239435. The details below separate the work described by the employer from essential conditions, preferred experience and practical preparation advice.

• Department: Value Capture
• Employer listing date: 29 September 2026

Responsibilities and work described

• The Associate, Risk Adjustment Auditor conducts internal and external quality audits
• Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities
• Work: with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs
• Report into the Manager, Risk Adjustment
• Work: Location: This is a remote position, open to candidates who reside in: Arizona
• Florida
• Georgia; or Texas
• While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote
• Pay Transparency: The base pay for this role is: $82,717 - $108,566 per year You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses
• Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation
• Review: the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented
• Maintenance: compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards
• Research / execution: CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits
• Development: relationships with key individuals to foster an increased understanding of the Risk Adjustment process
• Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business
• Management: the implementation process improvements that will maximize risk adjustment factor increases

Essential requirements and candidate background

• Bachelor's degree in a relevant field of study or commensurate work experience
• Certified professional coder (CPC)
• 3+ year(s) retrospective risk adjustment coding experience
• 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Preferred experience and additional strengths

• Certified Risk Adjustment Coder (CRC) or similar certification
• Experience coding in a variety of different Electronic Medical Record (EMR) systems
• This is an authentic Oscar Health job opportunity
• 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
• 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

Location, schedule and contract conditions

For this overseas or regional listing, confirm work authorisation and any location restrictions with the employer. The location does not establish visa sponsorship or permission to work remotely from India.

• 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
• Advertised location: Georgia, United States

Conditions requiring the complete notice

Some passages contain complex or combined conditions that have not been reduced to short eligibility statements here. Read the complete linked notice for those passages, including any alternatives, exceptions or restrictions. The concise facts above should not be treated as the full wording of every condition.

Pay and application dates

A verified salary figure is not established in this article. An online estimate for another Risk Adjustment Auditor vacancy is not an offer for reference 8239435; use the employer’s own pay disclosure and recruitment communication.

A closing date is not confirmed in this article. Check the current employer page before submitting: an undated posting can change or be withdrawn.

How to apply to Oscar Health

Applications follow the official employer page linked below.

Open the official Oscar Health posting below and match the title and reference 8239435.

Compare your qualifications and experience with the essential conditions for the Georgia, United States position, then read the preferred criteria separately.

Prepare an accurate CV and the supporting items requested in that employer’s application. Provide only information and documents you are authorised to share.

Use the employer’s application option, complete the required fields and review the submission. Retain the acknowledgement when one is provided. Job Alerts World does not receive the application.

Practical preparation: AI

An AI-related example should make the task and evaluation explicit. Explain the inputs, the system’s intended output and how you checked errors, usefulness or reliability, rather than relying on the model name alone.

Relevant skills

• AI/ML
• ACA
• AI
• quality assurance
• process improvement
• audit
• compliance
• insurance
• clinical documentation