Senior Specialist, Coding Auditor

Oscar Health•Remote, AZ

21h•$58,870 - $85,853•Remote

About The Position

We're hiring a Senior Specialist, Coding Auditor 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. 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. You will report into the VP, Payment Integrity. 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.

Requirements

1+ years of coding or auditing experience across multiple specialties.
Certified Professional Coder (CPC) designation or similar certification
Bachelor's degree or 4+ years of work experience
Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.

Nice To Haves

Certified Professional Medical Auditor
Payment Integrity audit experience
Demonstrated experience translating technical jargon to non-technical end users.
Experience with HIPAA, data privacy, and/or data security processes
Experience working with regulators governing (public or private) health insurance carriers

Responsibilities

Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.
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.
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.
Create reports and reference guides that can be used by other team members to communicate findings or more effectively perform similar reviews.
Assist in drafting written communications to providers to convey findings.
Participate in educational calls with providers.
Assist in the training of new team members.
Develop and document processes to improve the efficiency and effectiveness of the team.
Compliance with all applicable laws and regulations
Other duties as assigned