Senior Specialist, Coding Auditor

Hi, we're Oscar. We're 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

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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.

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 Oscar's 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

Bachelor's 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

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud

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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 and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency

Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.

Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (ai)

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AI Guidelines

outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s 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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