Coding Audit Manager, SIU

Oscar Health

Oscar Health

Remote
Posted on Friday, April 19, 2024

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

Oscar is the first health insurance company built around a full stack technology platform and a 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 Coding Audit Manager executes on Oscar’s anti-fraud initiatives by meeting operational and financial targets while adhering to legal and regulatory obligations. By leading a team who independently audits claims, you will set and execute on audit strategy while supporting and charting growth paths for direct reports’ personal development. The Coding Audit Manager fosters engagement across all partners, and creates policies, procedures and educational documentation to support an excellent Fraud Waste and Abuse (FWA) program. We ask that you have an understanding of managing direct and delegated FWA functions to align with operational needs.

You will report to the Associate Director, SIU.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $88,560 - $116,235 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

  • Lead and manage 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 complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.
  • 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 meetings by articulating findings to providers.
  • 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 prioritize and inform management before deadlines are missed.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Qualifications

  • Bachelor’s degree 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

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

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.

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.