Senior Manager, Payment Integrity (Chart Review)

Tempe, AZ - USA

Yearly Salary: $ 111034 - 145733

Posted on: 7 hours ago

Vacancies: 1 Vacancy

Job Summary

Hi were Oscar. Were hiring a Senior Manager Chart Review to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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 Chart Review leads and oversees Oscars internal pre-payment chart review program setting and holding the team accountable to performance and develops strategic plans to achieve 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 in order to enable the teams success. This person supports our teams in driving a best-in-class service-focused operation by designing guiding and assessing the effectiveness of the use of operational frameworks and ideologies.

You will report into the Vice President Payment Integrity.

Work Location: This position is based in our Tempe Arizona office requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency: The base pay for this role is: $111034 - $145733 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.

Responsibilities:

Lead oversee and grow Oscars internal pre-payment chart review program.
Lead a team to efficiently manage production inventory issues ensuring achievement of production and quality targets.
Anticipate overcome and prevent recurrence of complex problems and roadblocks in an efficient and effective manner.
Establish routines that foster cross-functional collaboration with technology and data science teams to enhance chart review Key Performance Indicators (KPIs): hit rate change rate and other productivity metrics.
Develop and implement standard Payment Integrity policies and procedures
Drive ideation of payment integrity opportunities
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 / KPIs.
Coach develop and lead a team to achieve identified outcomes.
Provide leadership in complex cross-functional 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

Requirements:

6 years experience in operations data analytics and/or consulting within healthcare
6 years of experience analyzing data to solve complex operational business problems
3 years of experience leading an operations production team
3 years experience designing implementing and improving business workflows
Ability to execute on multiple high priority projects within tight deadlines

Bonus points:

Medical coding certification through AAPC (CPC COC) or AHIMA (CCS RHIT RHIA)
Process Improvement or Lean Six Sigma training certification
Experience with healthcare claims processing
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 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.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

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.

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Required Experience:

Senior Manager

Hi were Oscar. Were hiring a Senior Manager Chart Review to join our Payment Integrity team.Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company...