Senior Specialist, Coding Auditor

Oscar Health

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Remote First seen 1 day, 5 hours ago Last seen 3 hours, 50 minutes ago Greenhouse

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Job Description

AI Summary

• Audits medical claims and documentation for accuracy and compliance with coding guidelines (CPT, HCPCS, ICD-10), performing both pre-payment and post-payment reviews to ensure proper reimbursement. • Requires CPC certification (or equivalent), 1+ years of coding/auditing experience across specialties, bachelor's degree or 4+ years work experience, and background in health insurance claims processing or provider contracting. • Creates detailed audit reports, reference guides, and provider communications; trains team members; and develops process improvements to enhance team efficiency and compliance. • Remote position available in 9 locations (Arizona, Georgia, Illinois, Texas, Kentucky, Minnesota, New York, Pennsylvania, Utah) with base pay of $58,870-$77,267 annually ($65,412-$85,853 in NYC), plus benefits, unlimited vacation, and performance bonuses. • Reports to VP of Payment Integrity with occasional travel required for team meetings and company events.

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:

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

Pay Transparency: The base pay for this role in New York City is: $65,412 - $85,853 per year. The base pay for this role in all other locations is: $58,870 - $77,267 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

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

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.

Bonus points:

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.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

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Job Information

Company:
Oscar Health
Location:
Remote
Job Type:
Contract
Work Location:
Remote
Experience Level:
Senior
Source:
Greenhouse
Status:
Active

Activity Score

76 /100

Likely Active (76)

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