Remote Medical Coding Auditor

Summary

Join Oscar's SIU team as a Medical Coding Auditor, and contribute to assessing trends and patterns in FWA across the healthcare industry. You will work with deep coding knowledge to audit prepayment and/or post payment claims, reducing the incidence and effect of fraud, waste, and/or abuse on all our operations.

Requirements

• 1+ years of coding or auditing experience across multiple specialties
• Bachelor’s degree or 4+ years of work experience

Responsibilities

• Develops and maintains a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements
• Perform 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
• 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
• Help draft written communications to providers to convey findings
• Participate in educational calls with providers
• Help train new team members
• Develop and document processes to improve the effectiveness of the team
• Compliance with all applicable laws and regulations
• Other duties as assigned

Benefits

• 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
• Paid wellness time and reimbursements