Manager, SIU Coding Audit Post-Pay

Summary

Join Oscar's Special Investigations Unit (SIU) as a Manager, SIU Coding Audit Post-Pay! You'll lead a team auditing medical claims, setting audit strategy, and ensuring compliance. This role involves managing performance metrics, reviewing medical records, documenting findings, and communicating with providers. The position requires a Bachelor's degree, 5+ years of coding experience, and a CPC designation. While based in NYC, Tempe, or LA, this role offers a blended work culture with remote options. Competitive salary and benefits are included, along with opportunities for professional growth.

Requirements

• 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

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

Preferred Qualifications

• 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

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
• Annual performance bonuses
• Oscar's unlimited vacation program