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Oscar Health // health insurance
 
Tempe, Arizona, United States    Posted: Saturday, August 08, 2020
 
   
 
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JOB DETAILS
 

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. You will oversee & coordinate clinical review cases from intake to notification. To do this, you will help 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 workflow. Learned to use our internal tools to manage your work & resolve or escalate issues. Begun to form relationships with fellow processors, the clinical reviewers (nurses & physicians) & essential external partners. Become comfortable working with providers by phone & in writing. Afterwards & on an ongoing basis: You continue to... answer questions on the clinical review process for in-network & out-of -network services. Support the team's development & continuous operational improvement by raising issues & identifying root cause to guide resolution. Take ownership of all authorization processing issues; monitoring, tracking, & stat using the health of the operation. Coordinate with our concierge teams to assist with discharge planning & any other UM needs of members on their panel. Support regulatory audits.

You will report into the Associate Ops Manager.

Responsibilities:

  • 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
  • Form strong relationships with fellow processors, the clinical reviewers (nurses & physicians) & essential external partners
  • Become comfortable working with providers by phone & in writing

Requirements:

  • In depth knowledge of UM authorization processing
  • Experience handling Personal Health Information (PHI)
  • Experience entering accurate data in a production-driven environment
  • 1+ years of health insurance or healthcare experience

Bonus points:

  • 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.

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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