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Oscar Health // health insurance
 
Remote    Posted: Monday, September 27, 2021
 
   
 
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JOB DETAILS
 

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

Oscar is the first health insurance company built around a full stack technology platform & a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.

About the role:

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

The Senior Analyst supports in assessing trends & patterns in FWA across the healthcare industry using their deep coding knowledge to prevent & recoup inappropriately paid claims. This 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 Director, SIU. This is a remote role, you will work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Responsibilities:

  • Develops & maintains a depth of expertise on CPT, HCPCS, & ICD-10 Coding guidelines & other insurance billing submission requirements.
  • Efficiently perform thorough & complex audits of assigned medical records & claims on both a prepayment & post payment basis to determine accuracy of claims submitted to Oscar.
  • Explicitly document findings including reference to sources used to support decision making & in a way that can be easily understood by non clinicians or coders.
  • Create audit report findings, tools, & reference guides that can be used by other team members to communicate findings or more effectively perform similar reviews.
  • Assist in drafting written communications to providers to convey audit findings.
  • Participate in educational calls with providers.
  • Assist in the training of new team members.
  • Develop & document processes to improve the efficiency & effectiveness of the team.
  •  

Requirements:

  • 3+ years of coding or auditing experience across multiple specialties.
  • Bachelors degree  or 4+ years of work experience
  • Certified Professional Coder (CPC) designation or similar
  • Demonstrated experience translating technical jargon to non-technical end users.

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.

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 aim to make health care affordable & accessible for all, & apply this same vision to our perks & benefits, including: 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.

COVID-19 vaccine requirements for in-person work: 

To protect the health & safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field & employees conducting at-home or in-person visits with members.

 
 
 
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