Posted about 4 years ago

Hi, we're Oscar. We’re hiring a Coding Audit Manager to join our SIU team. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health insurance simple, transparent, and human. We need your help to do so.

About the role:

The Special Investigations Unit (SIU) runs or coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse (“FWA”) on all our operations. 

Within the SIU, your primary role will be to support Oscar in its fight against fraud.  Joining this dynamic team will expose you to the latest trends and patterns in FWA across the healthcare industry – and provide you with the chance to fight FWA using your deep coding knowledge to prevent and recoup and prevent paying inappropriate claims.  Your work will not only lead to savings and recoupments for Oscar as a company, but to more affordable and higher-quality health care for the members we serve.

You will report into the SIU Director, who reports to the Compliance Officer. This is a remote role, you will work remotely in the United States in one of our approved states (see application questions).

Responsibilities:

• Lead a growing Coding Audit team that performs both prepayment and post payment reviews of medical records and claims
• Set and monitor performance and production metrics for the team to help achieve organizational vitals
• Provide insights and direction into operational processes and opportunities to improve efficiencies 
• Supervise and support the quality review process to evaluate coder effectiveness
• Perform thorough and 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.
• Communicate verbally and in written form the quality of other team members’ coding audit reviews to ensure accuracy and compliance with coding standards and Oscar policy.
• Review dashboards and interpret performance data to inform the Director of metrics before deadlines are missed.
• Train new team members.

Requirements:

• Bachelor’s degree (or equivalent experience) and 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] 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

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 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.

We encourage our members to care for their whole selves, and 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, and volunteer opportunities.

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 ([email protected]) 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.