Hi, were Oscar. Were hiring a Senior Specialist, Coding Auditor to join our Payment Integrity.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family.
About the role:
You will support issue resolution in the Oscar claim environment. You will be responsible for the end-to-end claims repayment quality, process improvement and supporting root cause analysis. You will report into the VP, Payment Integrity.
Work Location: This is a remote position, open to candidates who reside in: Tempe, Arizona; Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; New York City, New York; Philadelphia, Pennsylvania; Salt Lake City, Utah.
While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.
#LI-Remote
Pay Transparency: The base pay for this role in New York City is: $65,412 - $85,853 per year. The base pay for this role in all other locations is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscars unlimited vacation program, and annual performance bonuses.
Responsibilities:
• Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements. • Efficiently perform thorough and complex policy updates or audits of assigned documentation (i.e. medical records or claims) on both a prepayment and/or post payment basis to determine accuracy of claims submitted to Oscar. • Explicitly document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders. • Create reports and 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 findings. • Participate in educational calls with providers. • Assist in the training of new team members. • Develop and document processes to improve the efficiency and effectiveness of the team.
Compliance with all applicable laws and regulations
Other duties as assigned
Requirements:
1+ years of coding or auditing experience across multiple specialties. Certified Professional Coder (CPC) designation or similar certification Bachelors degree or 4+ years of work experience Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.
Bonus points:
Certified Professional Medical Auditor Payment Integrity audit experience Demonstrated experience translating technical jargon to non-technical end users. Experience with HIPAA, data privacy, and/or data security processes Experience working with regulators governing (public or private) health insurance carriers