SIU Coding Auditor
SIU Coding Auditor
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$ 63200 - 82950
1 Vacancy
Job Description
Hi were Oscar. Were hiring a SIU Coding Auditor 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 works in the Special Investigation Unit to support in assessing trends and patterns in FWA across the healthcare industry using deep coding knowledge to prevent and recoup inappropriately paid claims. The Specialist Investigation Unit runs and coordinates activities across Oscar to reduce the incidence and impact of fraud waste and/or abuse (FWA) on all our operations.
You will report to the Manager SIU Coding Audit.
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.
This is a hybrid role in our Los Angeles CA (Marina Del Rey) office. You will work part of the time in the office and part of the time remote / work-from-home. #LI-Hybrid
Pay Transparency:
The base pay for this role is: $63200 - $82950 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.
Responsibilities
- Develop a depth of expertise on CPT HCPCS and ICD-10 Coding guidelines and other insurance billing submission requirements.
- Perform complex audits of assigned medical records and claims on both a prepayment and 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 audit report findings tools and reference guide 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 audit 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
- 2 years of coding or auditing experience across multiple specialties is required
- Bachelors degree or 4 years of work experience
- Certified Professional Coder (CPC) Certified Inpatient Coder (CIC) Certified Outpatient Coder (COC) designation or similar certification
- Experience working in production-based environment
- Experience of both outpatient and inpatient auditing
Bonus Points
- Certified Professional Medical Auditor (CPMA)
- 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
- Demonstrated experience translating technical jargon to non-technical 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 discrimination-free 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. 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 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.
Employment Type
Full-Time
