Senior Manager, Payment Integrity (Chart Review)

Oscar Health•Tempe, AZ

3d•Hybrid

About The Position

The Senior Manager, Chart Review leads and oversees Oscar's internal pre-payment chart review program, setting and holding the team accountable to performance, and develops strategic plans to achieve outcomes. The Senior Manager plays a critical role in the overall claims improvement apparatus by providing leadership, structure and organization, including coaching and developing direct reports, in order to enable the team's success. This person supports our teams in driving a best-in-class, service-focused operation by designing, guiding and assessing the effectiveness of the use of operational frameworks and ideologies. You will report into the Vice President, Payment Integrity.

Requirements

6+ years experience in operations, data analytics and/or consulting within healthcare
6+ years of experience analyzing data to solve complex operational business problems
3+ years of experience leading an operations production team
3+ years experience designing, implementing and improving business workflows
Ability to execute on multiple high priority projects within tight deadlines

Nice To Haves

Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
Process Improvement or Lean Six Sigma training, certification
Experience with healthcare claims processing
Experience managing in a healthcare claims organization
Experience using SQL

Responsibilities

Lead, oversee, and grow Oscar's internal pre-payment chart review program.
Lead a team to efficiently manage production inventory issues, ensuring achievement of production and quality targets.
Anticipate, overcome, and prevent recurrence of complex problems and roadblocks in an efficient and effective manner.
Establish routines that foster cross-functional collaboration with technology and data science teams to enhance chart review Key Performance Indicators (KPIs): hit rate, change rate, and other productivity metrics.
Develop and implement standard Payment Integrity policies and procedures
Drive ideation of payment integrity opportunities
Participate in governance committee activities to ensure alignment with internal stakeholders & business decisions.
Translate a strategic vision for the team and outline clear and measurable performance metrics / KPIs.
Coach, develop and lead a team to achieve identified outcomes.
Provide leadership in complex, cross-functional initiatives focused on claims improvement.
Manage a portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators.
Compliance with all applicable laws and regulations
Other duties as assigned