Manager, SIU Coding Audit Post-Pay

Hi, we're Oscar. We're hiring a Manager, SIU Coding Audit Post-Pay to join our SIU team.

Oscar is the first health insurance company built around a full stack technology platform and a 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

The Manager, Special Investigations Unit Coding Auditor executes on Oscar’s anti-fraud programs by meeting operational and financial targets while following legal and regulatory obligations. By leading a team who independently audits claims, you will set and work on audit strategy while supporting and charting growth paths for direct reports’ personal development. The Coding Audit Manager fosters engagement across all partners, and creates policies, procedures and educational documentation to support an excellent Fraud Waste and Abuse (FWA) program. We ask that you have an understanding of managing direct and delegated FWA functions to align with operational needs.

You will report to the Associate Director, SIU.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $98,400 - $129,150 per year. The base pay for this role in all other locations is: $82,240 - $110,565 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Manage a Coding Audit team that performs both prepayment and post payment reviews of medical records and claims.
• Set and monitor performance and production metrics for the team to help achieve organizational vitals
• Provide insights and direction into operational processes and opportunities to increase efficiency 
• Manage the quality review process to evaluate coder effectiveness
• Perform complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.
• Document findings including sources used to support decision-making and in a way that can be easily understood by non clinicians or coders.
• Participate in meetings by explaining findings to providers.
• Communicate verbally and in written form the quality of other team members’ coding audit reviews to ensure accuracy and compliance with coding standards and Oscar policy.
• Review dashboards and interpret performance data to prioritize and inform management before deadlines are missed.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• Bachelor’s degree and 5+ years of coding experience with at least 3+ performing auditing across multiple specialties.
• Certified Professional Coder (CPC) designation or similar
• 2+ years of managing direct reports

Bonus Points

• Certified Professional Medical Auditor
• Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar
• Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
• Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.
• Experience with HIPAA, data privacy, and/or data security processes
• Experience working with regulators governing (public or private) health insurance carriers