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Oscar Health // health insurance
 
Miami, Florida, United States    Posted: Saturday, March 20, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. We're hiring a Manager to join our Insurance Operations team remotely out of Florida.

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:

The Payment Integrity team at Oscar focuses on Oscar's company-wide goal to make healthcare more affordable & efficient by designing scalable processes & building data-driven solutions powered by technology. Our work favorably impacts Oscar's price position through reducing claims payment leakage & surfacing & addressing fraudulent, wasteful, & abusive practices. The Payment Integrity team drives several operational programs, including payment policies & guidelines, high risk claims reviews, claims audit & edit processes.

You will oversee the development, reconciliation, & maintenance of Oscar's reimbursement policies for new partnerships, including assisting with the strategy that we deploy with our partners. You will ensure that all policies are implemented in a way that is supportive of Oscar's mission to increase the affordability of healthcare.

You will report to the Director of Payment Integrity Operations.

Responsibilities:

  • Develop an understanding of all partners & the markets they operate in & become the go-to-individual at the company for reimbursement policies.
  • Achieve reimbursement strategy including determining & uncovering new opportunities.
  • Work with partners to identify claims payment trends that conflict with the published reimbursement policies or industry standard billing practices to create educational opportunities with provider & to ensure proper coding & documentation.
  • Provide leadership & coaching to employees to allow team development that inspires positive results
  • Review industry rules & regulations (i.e. peer research, AMA guidelines , CCI & other CMS coding regulations, other federal & state regulations) to help develop reimbursement policies across all lines of business.
  • Work to project manage the end-to-end process of reimbursement policy drafting & publishing to Oscar's provider portal.
  • Oversee the financial impact analysis & requirements development for configuration of claim edits to support reimbursement policies.

Requirements:

  • 5+ years experience in healthcare reimbursement, healthcare claims, or healthcare payment integrity
  • Project management experience with large teams & projects
  • Experience drafting financial impact analyses
  • Exposure to medical claims data analysis
  • 2+ years experience leading a team

Bonus points:

  • Expertise in healthcare reimbursement policies or coding regulations

Life at Oscar:

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 our unique backgrounds & perspectives.

We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

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 (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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