Senior Manager Payment Integrity
Senior Manager Payment Integrity
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
$ 119200 - 156450
1 Vacancy
Job Description
Hi were Oscar. Were hiring a Senior Manager Payment Integrity to join our Payment Integrity 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 Manager Payment Integrity identifies and prioritizes claims improvement opportunities sets and holds teams accountable to performance and develops strategic plans to achieve overall payment integrity outcomes. The Senior Manager plays a critical role in the overall claims improvement apparatus by providing leadership structure and organization including coaching and developing direct reports and their teams in order to enable the teams success. This person supports our teams in driving a bestinclass servicefocused operation by designing guiding and assessing the effectiveness of the use of operational frameworks and ideologies.
You will report to the Senior Director Payment Integrity.
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 IllinoisIndiana 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: $119200 $156450 per year. The base pay for this role in all other locations is: $107280 $140805 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.
Responsibilities
- Be the subject matter expert for Payment Integrity policies and claims processing edits through knowledge and expertise of Oscars claim platform claim coding and regulatory requirements and operational workflows.
- Anticipate overcome and prevent recurrence of complex problems and roadblocks in an efficient and effective manner
- Create routines that drive crossfunctional collaboration within and outside of department
- Develop and implement standard Payment Integrity policies procedures and workflows
- Drive ideation of payment integrity opportunities
- Manage inquiries related to Oscar edits & disputes
- Monitor performance of Oscar edits including but not limited to monthly quality audits.
- Participate in governance committee activities to ensure alignment with internal stakeholders & business decisions.
- Translate a strategic vision for the team and outline clear and measurable performance metrics / OKRs.
- Coach develop and lead a team to achieve identified outcomes.
- Provide leadership in complex crossfunctional initiatives focused on claims improvement.
- Manage a portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- 6 years experience in operations healthcare data analytics and/or consulting
- 6 years of experience analyzing data to solve complex business problems
- 3 years of experience leading and developing a team
- 3 years experience designing implementing and improving business workflows
- 6 years experience in medical coding
- Medical coding certification through AAPC (CPC COC) or AHIMA (CCS RHIT RHIA)
- Expert level experience with reimbursement methodologies provider contract concepts and common claims processing/resolution practices.
Bonus Points
- Process Improvement or Lean Six Sigma training certification
- Experience managing in a healthcare claims organization
- Experience using SQL
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:
Senior Manager
Employment Type
Full-Time
