Senior Specialist, Coding Auditor

<p>Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity.</p> <p>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.</p> <p><strong>About the role:</strong></p> <p>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<strong>.</strong></p> <p>You will report into the VP, Payment Integrity.</p> <p><strong>Work Location: </strong>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</p> <p><strong>Pay Transparency: </strong>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.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.</li> <li>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.</li> <li>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.</li> <li>Create reports and reference guides that can be used by other team members to communicate findings or more effectively perform similar reviews.</li> <li>Assist in drafting written communications to providers to convey findings.</li> <li>Participate in educational calls with providers.</li> <li>Assist in the training of new team members.</li> <li>Develop and document processes to improve the efficiency and effectiveness of the team.</li> <li>Compliance with all applicable laws and regulations</li> <li>Other duties as assigned</li> </ul> <p><strong>Requirements:</strong></p> <ul> <li>1+ years of coding or auditing experience across multiple specialties.</li> <li>Certified Professional Coder (CPC) designation or similar certification</li> <li>Bachelor's degree or 4+ years of work experience</li> <li>Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.</li> </ul> <p><strong>Bonus points:</strong></p> <ul> <li>Certified Professional Medical Auditor</li> <li>Payment Integrity audit experience</li> <li>Demonstrated experience translating technical jargon to non-technical end users.</li> <li>Experience with HIPAA, data privacy, and/or data security processes</li> <li>Experience working with regulators governing (public or private) health insurance carriers</li> </ul><div class="content-conclusion"><p><span style="font-weight: 400;">This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud</span><a href="http://hioscar.com/careers/recruitment-fraud-alert"><span style="font-weight: 400;"> </span><span style="font-weight: 400;">here</span></a><span style="font-weight: 400;">. </span></p> <p><span style="font-weight: 400;">At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment ... (truncated, view full listing at source)