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
- 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.
- 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