Senior Specialist, Coding Auditor

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 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 here .
• Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
• California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy .

Benefits

Additional Information

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.

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