Manager, Data Mining - Payment Integrity

Oscar Health•Tempe, AZ

1d•$100,602 - $132,040•Hybrid

About The Position

The Manager of Data Mining leads a team of individual contributors, ensuring the team is meeting savings and recovery targets in the payment integrity space. You will lead data mining auditors in the post-payment payment integrity space, and oversee data mining vendor management. You will report into the Associate Director, Payment Integrity. This position is based in our Tempe, Arizona office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule.

Requirements

A bachelor’s degree or 4+ years of commensurate experience
4+ years experience in healthcare operations
2+ years of experience leading and developing a team
2+ years experience designing, implementing and improving business workflows

Nice To Haves

2+ years of payment integrity experience at a health plan or vendor organization
Experience with healthcare claims adjudication
Experience with SQL and basic SQL abilities
Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)

Responsibilities

Oversee the quality control process for data mining vendor submissions, ensuring accuracy and alignment with program standards
Lead the daily operations of the data mining team, including the strategic delegation of work to both internal auditors and external partners
Develop team workflows and guidelines that produce consistent and measurable outcomes.
Train, teach and mentor team members to become more proficient and effective.
Partner with Oscar's technology and/or data science teams to establish algorithms for savings and recovery identifications.
Compliance with all applicable laws and regulations
Other duties as assigned