[Hiring] Senior Specialist, Coding Auditor @Oscar Health

Role Description

Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity. 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.

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.

Qualifications

• 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.

Requirements

• 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.

Benefits

• 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.
• Paid wellness time and reimbursements.