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Oscar Health // health insurance
 
New York City, United States    Posted: Tuesday, June 08, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Coding Audit Manager to join our SIU team. 

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 Special Investigations Unit (SIU) runs or coordinates activities across Oscar to reduce the incidence & impact of fraud, waste, and/or abuse (FWA) on all our operations. 

Within the SIU, your primary role will be to support Oscar in its fight against fraud.  Joining this dynamic team will expose you to the latest trends & patterns in FWA across the healthcare industry & provide you with the chance to fight FWA using your deep coding knowledge to prevent & recoup & prevent paying inappropriate claims.  Your work will not only lead to savings & recoupments for Oscar as a company, but to more affordable & higher-quality health care for the members we serve.

You will report into the SIU Director, who reports to the Compliance Officer.

Responsibilities:

  • Lead a growing Coding Audit team that performs both prepayment & post payment reviews of medical records & claims
  • Set & monitor performance & production metrics for the team to help achieve organizational vitals
  • Provide insights & direction into operational processes & opportunities to improve efficiencies 
  • Supervise & support the quality review process to evaluate coder effectiveness
  • Perform thorough & complex reviews of medical records & claims on both a prepayment & post payment basis to determine accuracy of claims submitted to Oscar.
  • Explicitly document findings including sources used to support decision making & in a way that can be easily understood by non clinicians or coders.
  • Participate in educational calls or written communications to articulate findings to providers under SIU review.
  • Communicate verbally & in written form the quality of other team members coding audit reviews to ensure accuracy & compliance with coding standards & Oscar policy.
  • Review dashboards & interpret performance data to inform the Director of metrics before deadlines are missed.
  • Train new team members.

Requirements:

  • Bachelors degree (or equivalent experience) & 5+ years of coding experience with at least 3+ performing auditing across multiple specialties.
  • Certified Professional Coder (CPC) designation or similar
  • 2+ years of managing direct reports

Bonus points:

  • Certified Professional Medical Auditor
  • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] & Fraud Professional (CAFP), other coding certifications or similar
  • Knowledge of applicable fraud statutes & regulations, & of federal guidelines on recoupments & other anti-FWA activity
  • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.
  • Experience with HIPAA, data privacy, and/or data security processes
  • Experience working with regulators governing (public or private) health insurance carriers

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 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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