Senior Specialist, Coding Auditor

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Quick Summary

Key Responsibilities

Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission

Technical Tools

OtherAuditorAudit

Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity.

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.

About the Role

~1 min read

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.

Responsibilities

~1 min read

→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

Requirements

~1 min read

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 Have

~2 min read

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

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

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