Manager SIU Coding Audit Post-Pay
Manager SIU Coding Audit Post-Pay
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$ 98400 - 129150
1 Vacancy
Job Description
Hi were Oscar. Were hiring a Manager SIU Coding Audit PostPay 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 Manager Special Investigations Unit Coding Auditor executes on Oscars antifraud 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 / workfromhome 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. #LIRemote
Pay Transparency:
The base pay for this role in the states of California Connecticut New Jersey New York and Washington is: $98400 $129150 per year. The base pay for this role in all other locations is: $82240 $110565 per year. You are also eligible for employee benefits participation in Oscars 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 decisionmaking 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
- Bachelors 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 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
- 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.
Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.
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.
Required Experience:
Manager
Employment Type
Full-Time
