SIU Coding Auditor

Hi, we're Oscar. We're hiring an Associate, SIU Coding Auditor to join our SIU.

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

The Associate, Special Investigations Unit Coding Auditor executes on Oscar's anti-fraud initiatives by supporting operational and financial targets while adhering to legal and regulatory obligations. You will help execute on audit strategy by ensuring team productivity is met while ensuring quality remains high. The associate networks across all partners, and recommends enhancements to processes, policies, and procedures to support a best in class Fraud Waste and Abuse program. We ask that you have attention to detail, innovation, and ability to shift priorities to align with operational needs.

You will report into the Manager, SIU Coding Audit.

Work Location

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. 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 is: $75,265 - $98,785 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

Perform quality checks of other team members' coding audit reviews and deliver in written or verbal form to ensure accuracy and compliance with coding standards and Oscar policy.

Review dashboards and interpret performance data in support of production goals; Recommend response and inform management before deadlines are missed.

Identify and help develop new processes to ensure efficient and effective audit functions.

Perform complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.

Explicitly document findings including sources used to support decision making and in a way that can be easily understood by non clinicians or coders.

Participate in educational calls or written communications to articulate findings to providers under SIU review.

Facilitate team and cross-team education

Compliance with all applicable laws and regulations

Other duties as assigned

Requirements

Bachelor's degree or equivalent years of experience

Certified Professional Coder (CPC) designation or similar

3+ years of coding or auditing experience across multiple specialties.

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] and Fraud Professional (CAFP), other coding certifications or similar

Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and 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

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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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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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