Associate, Regulatory Compliance (Risk Adjustment) - Remote

Hi, we're Oscar. We're hiring an Associate, Regulatory Compliance (Risk Adjustment) to join our Corporate Compliance 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
The Associate, Regulatory Compliance (Risk Adjustment) will partner and collaborate with the Compliance, Legal, and Risk Adjustment teams on Oscar’s Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business. You will be an important contributor to Oscar’s compliance program carrying out tasks associated with the program.
You will report to the Director Corporate Compliance.
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 New York City office ( in Hudson Square), our Tempe office (off the 101 at University Ave), or our Los Angeles office (in Marina Del Rey), you will be expected 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: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change.
Pay Transparency
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.
Responsibilities

• Collaborate with the RA team to implement RA practices.
• Develop compliance colleagues on the development of audit tools to assess RA compliance.
• Develop appropriate compliance policies and procedures.
• Develop relationships with partners to foster an increased understanding of RA compliance.
• Partner with compliance leadership and team to ensure the appropriate functioning of the corporate compliance program.
• Work with other department leaders/managers to ensure risk adjustment (RA) compliance is monitored and practices are following industry standards.
• Monitor resources available including: REGTAP, EDGE, CMS, HHS providing summaries and distributing information.
• Prepare appropriate reports for the Board, Director of Compliance, VP of Compliance and other senior leaders.
• Research to maintain a working knowledge of the RA regulations; interpret and apply the requirements across the enterprise.
• Participate in CMS audits of RA activities, including RA Data Validation audits.

Qualifications

• 3+ years’ experience in health plan RA compliance, regulatory affairs, government affairs, or a similar field..
• Experience managing complicated projects, keeping track of details, and staging work to complete projects on time.
• Experience with CMS and ACA regulatory compliance
• Knowledge of Risk Adjustment
• Regulatory requirements to business and technical staff to capture information.
• Experience developing reporting and metrics.
• Bachelor’s Degree or 4 years commensurate work experience.
• Prior experience working with regulators on RA audits, compliance audits, reporting and other matters.

Bonus Points

• Certified Professional Compliance Officer (CPCO)
• Professional Academy of Healthcare Management (PAHM)
• Certified Risk Adjustment Coder (CRC)
• Knowledge of CMS and ACA rules
• Direct experience in health care – ideally health insurance – compliance

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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 ([email protected]) to make the need for an accommodation known.