Senior Specialist, Coding Auditor
About The Position
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. Work Location: 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
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
Benefits
- medical, dental, and vision benefits
- 11 paid holidays
- paid sick time
- paid parental leave
- 401(k) plan participation
- life and disability insurance
- paid wellness time and reimbursements
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
