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Hi, we're Oscar. We're hiring a Coding Audit Manager, SIU to join our SIU team.
Oscar is the first health insurance company built around a full stack technology platform & a 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 Coding Audit Manager executes on Oscars anti-fraud initiatives by meeting operational & financial targets while adhering to legal & regulatory obligations. By leading a team who independently audits claims, you will set & execute on audit strategy while supporting & charting growth paths for direct reports personal development. The Coding Audit Manager fosters engagement across all partners, & creates policies, procedures & educational documentation to support an excellent Fraud Waste & Abuse (FWA) program. We ask that you have an understanding of managing direct & delegated FWA functions to align with operational needs.
You will report to the Associate Director, SIU.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture & our mission.
If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
Pay Transparency:
The base pay for this role in the states of California, Connecticut, New Jersey, New York, & Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscars unlimited vacation program & annual performance bonuses.
Responsibilities
- Lead & manage 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 complex reviews of medical records & claims on both a prepayment & post payment basis to determine accuracy of claims submitted to Oscar.
- Document findings including sources used to support decision-making & in a way that can be easily understood by non clinicians or coders.
- Participate in meetings by articulating findings to providers.
- 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 prioritize & inform management before deadlines are missed.
- Compliance with all applicable laws & regulations
- Other duties as assigned
Qualifications
- Bachelors degree & 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
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
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..
Pay Transparency:
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, & experience.
Full-time employees are eligible for benefits including: medical, dental, & vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life & disability insurance, & paid wellness time & reimbursements.
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.
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