Hi, we're Oscar. Were hiring a CRT Processor to join our Clinical Review Team (CRT) team in our Tempe 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:
We deal with our members' most sensitive issues & are looking for someone who can contribute positively to the level of work we do. In this role, you will be responsible for owning & coordinating clinical review cases from intake to notification. To do this, you will help to build clinical review cases, communicate with providers & facilities (via phone or email), coordinate with our clinicians & other Oscar teams, & ensure compliance to state regulations & NCQA standards.
Developed a comprehensive understanding of Oscar's clinical review processes & overall workflowLearned to use our internal tools to manage your work & resolve or escalate issues as neededBegun to form strong working relationships with fellow processors, the clinical reviewers (nurses & physicians) & key external partnersBecome comfortable interacting with providers via phone & in writingAfterwards & on an ongoing basis:You continue to...Be able to answer questions on the clinical review process for in-network & out-of -network servicesSupport the team's development & continuous operational improvement by raising issues & helping to identify root cause to drive resolutionTake ownership of all authorization processing issues; monitoring, tracking, & statusing the health of the operationCoordinate with our concierge teams to assist with discharge planning & any other UM needs of members on their panelSupport regulatory audits as needed
You will report into the Associate Ops Manager.
- Developed a comprehensive understanding of Oscar's clinical review processes & overall workflow
- Learned to use our internal tools to manage your work & resolve or escalate issues as needed
- Begun to form strong working relationships with fellow processors, the clinical reviewers (nurses & physicians) & key external partners
- Become comfortable interacting with providers via phone & in writing
- In depth knowledge of UM authorization processing
- Experience handling Personal Health Information (PHI) in a professional manner
- Experience entering accurate data in a production-driven environment
- 1+ years of health insurance or healthcare experience
- Bachelors degree
- Knowledge of authorization processing & medical terminology
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.
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 (firstname.lastname@example.org) 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.