Talent.com
Senior Specialist, Coding Auditor
Senior Specialist, Coding AuditorOscar Health • New York, NY, US
Senior Specialist, Coding Auditor

Senior Specialist, Coding Auditor

Oscar Health • New York, NY, US
30+ days ago
Job type
  • Full-time
Job description

Job Description

Job Description

Hi, we're Oscar. We're hiring a SIU Coding Auditor 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 Senior Specialist works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse ("FWA") on all our operations.

You will report to the Manager, SIU Coding Audit.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. 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 the states of New Jersey and New York is: $65,412 - $85,853 per year. The base pay for this role 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 a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.
  • Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.
  • 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 audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews.
  • Help draft written communications to providers to convey audit findings.
  • Participate in educational calls with providers.
  • Help train new team members.
  • Develop and document processes to improve the effectiveness of the team.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned
Qualifications
  • 2+ years of coding or auditing experience across multiple specialties is required
  • Bachelor's degree or 4+ years of work experience
  • Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification
  • Experience working in production-based environment
  • Experience of both outpatient and inpatient auditing
Bonus Points
  • Certified Professional Medical Auditor (CPMA)
  • 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
  • Demonstrated experience translating technical jargon to non-technical end users.
  • 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.

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.

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.

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.

Create a job alert for this search

Senior Specialist, Coding Auditor • New York, NY, US

Similar jobs

Senior Internal Auditor

New York TimesNew York, NY, United States
Full-time

We are looking for a tech-forward, strategic thinker to join our team as we redefine Internal Audit for 2026.In this role as an experienced Senior Auditor, you will plan and execute operational aud...Show more

 • Promoted

Senior Clinical Coding Auditor & Trainer (Remote) ( OK, KS, MO, TX, AR )

CRD Careers (Independent Recruiters)New York City, NY, United States
Remote
Full-time

A national managed care organization is expanding its clinical coding quality and education programs and this seniorlevel role sits at the center of that mission.Youll lead inpatient coding audits ...Show more

 • Promoted

Certified Professional Coder

SUNY College of OptometryNew York, NY, United States
Full-time

The University Eye Center (UEC) of the State University of New York College of Optometry, an Article 28 Diagnostic and Treatment Center, is seeking a Certified Professional Coder.The successful can...Show more

 • Promoted

Certified Coding Auditor

St. Joseph’s Healthcare SystemPassaic, NJ, United States
Full-time +1

Responsible for accurately abstracting data following the Official International Classification of Diseases (ICD)-10-Clinical Modification (CM), Current Procedural Terminology (CPT), and Healthcare...Show more

 • Promoted

Senior Auditor

NYC JobsNew York, NY, United States
Full-time

The Campaign Finance Board is a nonpartisan, independent city agency that empowers New Yorkers to have a greater impact on their elections.Our mission is to make local democracy more open, transpar...Show more

 • Promoted

Senior Clinical Coding Auditor & Trainer-Remote

Fox Point Recruitment LLCNew York City, NY, United States
Remote
Full-time +1

Job DescriptionJob DescriptionJob Summary / PurposeThe Senior Clinical Coding Auditor & Trainer will conduct audits of inpatient coding processes for Fidelis Care and assist in development of train...Show more

 • Promoted

Senior Internal Auditor

Artius SolutionsNew York, NY, United States
Full-time

Salt Lake City, UT | Dallas, TX | New York, NY.High chance of extension and fulltime conversion.Our client is looking to engage a Senior Internal Auditor to support ongoing audit and risk initiativ...Show more

 • Promoted

Strategic Projects Lead - Coding

Scale AI, Inc.New York, New York, United States
Full-time

Scale's Generative AI business unit is currently seeing historic levels of growth.As a Strategic Projects Lead (SPL), you will lead initiatives that will drive $XXM+ in new revenue for the business...Show more

 • Promoted

Senior Internal Auditor

Groupe BPCENew York, NY, United States
Full-time

The overall purpose of the Senior Internal Auditor is to conduct audit assignments within the CIB Americas Platform to ensure that the activities and practices are consistent with Bank Standards, R...Show more

 • Promoted

Senior Auditor Corporate

JetBlueLong Island City, NY, United States
Full-time

We are embarking on an exciting transformation to evolve JetBlue's Corporate Audit function into a modern, data-driven, collaborative partner to the business.We are seeking a Senior who will play a...Show more

 • Promoted

Senior Manager - Capital Markets, Internal Audit

Royal Bank of CanadaJersey City, NJ, United States
Full-time

As a Senior Manager - Capital Markets, responsible for coverage of a specific business within RBC Capital Markets US, performing continuous risk monitoring activities to develop and maintain the an...Show more

 • Promoted

Senior Internal Auditor

RichemontNew York, NY, United States
Permanent

Senior Internal Auditor Richemont.Richemont, one of the world leaders in the luxury sector, has various Houses specializing in jewelry, watches and high-end accessories.Each Maison proudly embodies...Show more

 • Promoted

Senior Auditor Associate CIB Technology

JPMorgan ChaseJersey City, NJ, United States
Full-time

Internal Audit is an independent function at JPMorgan Chase that aims to enhance and protect the firm by assessing the adequacy of the control environments across the firm's lines of businesses.Thi...Show more

 • Promoted

Audit Senior

DDKNew York, NY, United States
Full-time

DDK & Company LLP is a mid-sized CPA and Business Consulting Firm with office locations in Midtown Manhattan and Jericho, Long Island.The Firm provides services in a diverse array of industries.At ...Show more

 • Promoted

Senior Internal Auditor (SOX)

DLA, LLCNew York, NY, United States
Full-time

As a leading firm focused on internal audit, accounting and corporate finance, our goal at DLA, LLC is to continuously develop our employees and to embrace a culture that combines fun with hard wor...Show more

 • Promoted

Senior Auditor

Metropolitan Transportation AuthorityNew York, NY, United States
Full-time

Job Title: Senior Auditor/Analyst.Office of the Inspector General/Metropolitan Transportation Authority.Office of the Metropolitan Transportation Authority Inspector General:.The Office of the Metr...Show more

 • Promoted

Senior Auditor

New York City Department Of InvestigationNew York, NY, United States
Full-time

The Campaign Finance Board is a nonpartisan, independent city agency that empowers New Yorkers to have a greater impact on their elections.Our mission is to make local democracy more open, transpar...Show more

 • Promoted

Senior Internal Auditor Global Banks

RSMNew York, NY, United States
Full-time

Senior Internal Auditor Global Banks.We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our cl...Show more