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Oscar Health // health insurance
 
New York City    Posted: Friday, November 20, 2020
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Medical Coding Auditor to join our Insurance Operations team in our Tempe, Arizona office. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.

About the role:

When you come in, you will do crucial medical auditing on appropriate coding & billing norms, which will enable Oscar to scale the fraud, waste, & abuse (FWA) program. These outcomes will propel Oscars priorities & will have a lasting impact on our ability to provide affordable health care to all our members.

You will report into the Associate Operations Manager, Medical Coding.

You will:

  • Review claims / medical records to determine validity of payment due to potential fraudulent, wasteful, & abusive care
  • Communicate review findings internally with FWA & SIU teams
  • Conduct clear documentation of inconsistencies with claims billed vs health plan payments 
  • Provide subject matter expertise on FWA cases (including medical chart review) 
  • Train team members & key stakeholders on appropriate coding & billing norms
  • Identify & recommend opportunities for process improvements (including tools & systems) to help us work smarter
  • Manage high priority projects simultaneously while maintaining production standards

Requirements:

  • 5+ years of medical coding experience  
  • 3+ years doing Medical Auditing
  • Professional certification in medical coding (CPC or CCS AAPC Certified)
  • Knowledge auditing coding for E&M, CPT codes, diagnosis codes, procedure codes, modifiers, & billing edits
  • Experience in fraud, waste, & abuse

Bonus points:

  • Proficiency in DRG coding is a plus
  • Exposure to payment integrity & payment policy optimization

Life at Oscar: 

Our more than 1,000 employees aim to make health care affordable & accessible for all. We apply this same vision to our perks & benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

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 & find both belonging & support. We're on a mission to change health care -- an experience made whole by your unique background & perspectives.

Reasonable Accommodation

Oscar applicants are considered solely based on their qualifications, without regard to applicants 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.

Pay Transparency Policy

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

 
 
 
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