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Oscar Health // health insurance
 
New York City, United States    Posted: Thursday, June 25, 2020
 
   
 
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JOB DETAILS
 

What we want you for

We are changing how health insurance works. We want to create a healthcare experience thats intuitive & puts people, not cost or workflows, first. Were using a consumer-focused & tech-driven approach to do so. This positions us uniquely in the space - & creates one of the biggest opportunities in healthcare.

In this role, you will assist in key operations for a core Oscar insurance function called Value Capture. Under the Value Capture umbrella exists Risk Adjustment & Quality which are the only operations that can affect Oscars bottom line after weve set premium rates. Youll build & refine workflows, tracking progress to meet critical CMS deadlines. Youll help manage data for health systems, vendor partners, & internal stakeholders. Youll identify inefficiencies & recommend tactical program improvements. This position requires you to be data & operationally savvy.

What is the position?

Your role will be focused on overseeing the encounter submission process to CMS (Centers for Medicare & Medicaid Services) for ACA & MA lines of business. Youll work cross functionally with the Data Science, Actuarial, & Value Capture teams on standing up our encounter submissions. Candidates should possess experience working with large data sets & enjoy owning an operation end to end.

You will report into the Senior Manager of Value Capture

Responsibilities:

  • Work with Engineering / Product to set up servers & ensure plan reference tables are correct
  • Work cross functionally with Engineering team to ensure a seamless submission process & track error rates
  • Work with the Data Science team to ensure risk scores reconcile with internal CMS model & communicate findings with business stakeholders
  • Project Manage vendor for CMS RAPS/EDS submissions
  • Youll build dashboards to monitor progress of Value Capture programs & escalate issues with key stakeholders.
  • Youll assist, on an ongoing basis, the development & implementation of policies & procedures for Value Capture programs under the Affordable Care Act & Medicare.
  • Youll think creatively about whats possible for Value Capture programs & Oscars analytics & reporting tools/infrastructure.

Qualifications:

  • BA/BS Degree
  • Proficient in SQL (3+ years)
  • Experience with Python or another scripting language (2+ years)
  • Background in healthcare or in tech
  • Excited to build programs from the ground up
  • Creatively problem-solve & fix hidden inefficiencies

We think it will make a big (positive) difference if you have:

  • Masters degree preferred
  • 3+ years of healthcare experience or Risk Adjustment / Ops capacity
 
 
 
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