Manager, Data Mining - Payment Integrity

Oscar Health•Tempe, AZ

19h•Hybrid

About The Position

We're Oscar. We're hiring a Manager, Data Mining to join our Payment Integrity team. 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. 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.

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