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Senior Specialist, Coding Auditor

Senior Specialist, Coding Auditor

Oscar HealthNew York, NY, US
10 days ago
Job type
  • Full-time
Job description

Job Description

Job Description

Hi, we're Oscar. We're hiring a Senior Specialist, 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 to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to audit prepayment and / or post payment claims. The Senior Specialist runs and coordinates activities across Oscar to reduce the incidence and effect of fraud, waste, and abuse ("FWA") on all our operations.

You will report to the Manager, SIU Coding Audit Post-Pay.

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.

This is a remote position, open to candidates who reside in the following location(s) : Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, 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. While your day-to-day work will be completed from your home office, occasional travel may be required for key team meetings and company events. #LI-Remote

Pay Transparency :

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is : $63,200 - $82,950 per year. The base pay for this role in all other locations is : $56,800 - $74,655 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.
  • Perform 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.
  • 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.
  • Help draft written communications to providers to convey findings.
  • Participate in educational calls with providers.
  • Help train new team members.
  • Develop and document processes to improve the efficiency of the team.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Qualifications

  • 1+ years of auditing experience across multiple specialties.
  • Certified Professional Coder (CPC) designation or similar certification (required for SIU)
  • Bachelor's degree or 4+ years of work experience
  • 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
  • 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.

    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.

    Artificial Intelligence (AI) Guidelines : Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.

    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 Notice to Job Applicants.

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