Role Description 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. The Associate, Risk Adjustment Auditor works with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs. You will 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. Responsibilities - Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts. - 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. - Maintain 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. - Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits. - Develop 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. - Manage the implementation process improvements that will maximize risk adjustment factor increases. - Compliance with all applicable laws and regulations. - Other duties as assigned. Qualifications - 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. Bonus Points - Certified Risk Adjustment Coder (CRC) or similar certification. - Experience coding in a variety of different Electronic Medical Record (EMR) systems. Benefits - Medical, dental, and vision benefits. - 11 paid holidays. - Paid sick time. - Paid parental leave. - 401(k) plan participation. - Life and disability insurance. - Paid wellness time and reimbursements. Company Description 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.

Role Description Lead Auditor - GMP Quality Audits will perform high level assessments of quality systems in a variety of manufacturing sites, farms, processing plants and/or other work related sites throughout a region or country. - Assess and report in accordance with UL, industry scheme, and client audit protocols on facilities working and/or operational conditions as it relates to established industry standard(s) for GMP, Quality Systems, Food Safety initiatives and/or client programs. - Maintain a high level of technical knowledge and play an active mentoring role with trainees, auditors and lead auditors in the field. - Participate and lead higher level audits; involving complex methodologies, advanced analysis, and comprehensive/intricate reporting. Reports will be written in English in an objective, accurate, detailed and timely manner. - Specific Regulatory Standard(s) Competency are a focus including: - OTC Drug/Pharmaceuticals: 21CFR211/210 - Nutritional Supplements: 21CFR111 - Medical/Homecare Devices: 21CFR820 - Cosmetics: ISO22716 - Complete audit agendas within 14 calendar days of the audit. - Complete reports within 4 calendar days of the audit. - Submit audit expenses in a timely manner. - Complete at least 10 days of audits per month minimum capacity. Company Description A global leader in applied safety science, UL Solutions (NYSE: ULS) transforms safety, security and sustainability challenges into opportunities for customers in more than 110 countries. - UL Solutions delivers testing, inspection and certification services, together with software products and advisory offerings, that support our customers’ product innovation and business growth. - The UL Mark serves as a recognized symbol of trust in our customers’ products and reflects an unwavering commitment to advancing our safety mission. - We help our customers innovate, launch new products and services, navigate global markets and complex supply chains, and grow sustainably and responsibly into the future. - Our science is your advantage. - From life jackets to lawnmowers, toys to televisions, beauty and wellness, vitamins and supplements, we’re involved in almost every consumer product you can imagine. - We work with some of the largest retailers in the world, performing market surveillance, auditing and inspecting the products we put in and on our bodies. - We help customers ensure that not only are their products themselves safe, but their supply chains are using ethically and sustainably sourced materials. - We build close relationships, providing advice and expertise to help them deliver safer products that meet the latest requirements and manufacture them fairly. - Join our team and make your mark on products that shape people’s lives.

Role Description The Medical Records Technician (Coder-Auditor) serves as an expert in current coding conventions and guidelines related to professional and facility coding. Auditors perform audits of encounters to identify areas of noncompliance in coding. - Work Schedule: 8:00am to 4:30pm, Monday-Friday - Compressed/Flexible: Not Authorized - Remote: These approved positions are currently designated for a mid-term extension to the return to office mandate through October 2025. While these positions may be filled as remote, the employee will be required to return to the office if the mid-term extension is not continued. Therefore, all applicants must be located within 50 miles of a VA facility. - Telework: Once returned to the office, Telework may be approved as ADHOC, depending on Supervisor approval. - Virtual: This is not a virtual position. - Functional Statement #: 10444-F - Relocation/Recruitment Incentives: Not Authorized - Permanent Change of Station (PCS): Not Authorized - PCS Appraised Value Offer (AVO): Not Authorized Major Duties include but are not limited to the following: - Reviews coding and assists coders in improving coding accuracy; provides coding guidance to various levels of staff to promote consistency in practice and compliance with coding rules and regulations; initiates various reports and analyzes data. - Monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the VAMC. - Reviews assigned codes from the current version of several coding systems to include current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS). - Applies guidelines specific to certain diagnoses, procedures, and other criteria used to classify patients, under the Veterans Equitable Resource Allocation (VERA) program that categorizes all VA patients into specific classes representing their clinical conditions and resource needs. - Responsible for performing audits of coded data, developing criteria, collecting data, graphing and analyzing results, creating reports, and communicating in writing and/or in person to appropriate leadership and groups. - Audits accurate and complete assignment of ICD-10-CM, ICD-10-CPT and/or ICD-10-PCS codes, MS-DRG, POA status, and discharge disposition values for health records as assigned. Audit function includes evaluation of clinical documentation to support optimal code assignment. - Maintains statistical database(s) to track the results and validate the program for identifying patterns and variations in coding practices with regular reports to the medical staff and management. - Researches complex coding issues and participates in process improvements related to coding. - Provides training and education to coding and clinical staff to improve coding accuracy. Qualifications - Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. - Basic Requirements: - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience and Education: - 1. Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - OR, - 2. Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy and physiology, medical coding, and introduction to health records); - OR, - 3. Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. The training program must have led to eligibility for coding certification/certification examination, and the sponsoring academic institution must have been accredited by a national U.S. Department of Education accreditor, or comparable international accrediting authority at the time the program was completed; - OR, - 4. Experience/Education Combination: Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. Requirements - Certification: Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must have either: - (1) Apprentice/Associate Level Certification through AHIMA or AAPC. - (2) Mastery Level Certification through AHIMA or AAPC. - (3) Clinical Documentation Improvement Certification through AHIMA or ACDIS. - English Language Proficiency: MRTs (Coder) must be proficient in spoken and written English as required by 38 U.S.C. § 7403(f). Benefits - May qualify based on being covered by the Grandfathering Provision as described in the VA Qualification Standard for this occupation (only applicable to current VHA employees who are in this occupation and meet the criteria). Grade Determinations - Medical Records Technician (Coder) Auditor, GS-9. - The MRT (Coder) Auditor assignment is a position above the journey level. - Experience: One year of creditable experience equivalent to the journey grade level of a MRT (Coder), GS-8. - Certification: Employees at this level must have a mastery level certification. - Demonstrated Knowledge, Skills, and Abilities: - Advanced knowledge of current coding classification systems such as ICD, CPT, and HCPCS for the subspecialty being assigned (outpatient, inpatient, outpatient and inpatient combined). - Ability to research and solve complex questions related to coding conventions and guidelines in an accurate and timely manner. - Ability to review coded data and supporting documentation to identify adherence to applicable standards, coding conventions and guidelines, and documentation requirements. - Ability to format and present audit results, identify trends, and provide guidance to improve accuracy. - Skill in interpersonal relations and conflict resolution to deal with individuals at all organizational levels. Physical Requirements - See VA Directive and Handbook 5019. - The full performance level of this vacancy is GS-9.

• Conducts internal and/or external timely operational, financial, and/or compliance audits • Identifies, documents, and evaluates business risks • Develops written audit programs • Conducts testing and analysis of existing controls • Prepares written work papers to document testing results and conclusions • Serves as Lead Auditor on more complex audit assignments • Drafts recommendations to limit risks and improve processes • Writes audit reports for corporate executive management • Collects and analyzes data to detect deficient controls, duplicated effort, fraud, or non-compliance with laws • Conducts testing of corrective actions • Develops detailed reports on each audit conducted • Conducts special audit studies for management • Provides training to and assists or leads other auditors