Medical Coding Auditor SIU
Medical Coding Auditor SIU
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$ 56880 - 74655
1 Vacancy
Job Description
Hi were Oscar. Were hiring a Medical Coding Auditor SIU 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 ourselvesone that behaves like a doctor in the family.
About the role
The Senior Specialist Medical Coding Auditor SIU works to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to audit prepayment and/or post payment claims. The Senior Specialist runs and coordinates activities across Oscar to reduce the incidence and effect of fraud waste and/or abuse (FWA) on all our operations.
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 / workfromhome role.
You must reside in one of the following states: Alabama Arizona California Colorado Connecticut Florida Georgia Illinois 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. #LIRemote
Pay Transparency:
The base pay for this role in the states of California Connecticut New Jersey New York and Washington is: $63200 $82950 per year. The base pay for this role in all other locations is: $56880 $74655 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.
Responsibilities
- Develops and maintains a depth of expertise on CPT HCPCS and ICD10 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
Qualifications
- 1 years of coding or auditing experience across multiple specialties.
- Bachelors degree or 4 years of work experience
Bonus Points
- Certified Professional Coder (CPC) designation or similar certification (required for SIU)
- Certified Professional Medical Auditor
- Additional certification applicable to this work such as Certified Fraud Examiner (CFE) Accredited Healthcare Fraud Investigator (AHFI) Certified AML AntiMoney 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 antiFWA activity
- Demonstrated experience translating technical jargon to nontechnical end users.
- 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
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 discriminationfree hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. Were 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. Fulltime 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.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team 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 Notice to Job Applicants.
Employment Type
Full-Time
