Senior Coding Audit Analyst, SIU (Remote)

Hi, we're Oscar. We’re hiring a Senior Coding Audit Analyst to join our SIU 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 ourselves—one that behaves like a doctor in the family.

About the role:

The SIU runs or coordinates activities across Oscar to reduce the incidence and impact of fraud, waste, and/or abuse (“FWA”) on all our operations. 

The Senior Analyst supports in assessing trends and patterns in FWA across the healthcare industry using their deep coding knowledge to prevent and recoup inappropriately paid claims. This work will not only lead to savings and recoupments for Oscar as a company, but to more affordable and higher-quality health care for the members we serve.

You will report into the Director, SIU. This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Responsibilities:

Develops and maintains a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.

Efficiently perform thorough and complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.

Explicitly 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 guides that can be used by other team members to communicate findings or more effectively perform similar reviews.

Assist in drafting written communications to providers to convey audit findings.

Participate in educational calls with providers.

Assist in the training of new team members.

Develop and document processes to improve the efficiency and effectiveness of the team.

Requirements:

3+ years of coding or auditing experience across multiple specialties.

Bachelor’s degree or 4+ years of work experience

Certified Professional Coder (CPC) designation or similar

Demonstrated experience translating technical jargon to non-technical end users.

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 [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

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

Life at Oscar: 

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. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.