Senior Specialist, Coding Auditor

2 hours, 54 minutes ago
Full-time
Junior
Quality Assurance and Testing
Oscar

Oscar

Oscar is a health insurance company that offers plans for individuals, families, and small businesses. With a focus on humanizing health care through technology, design, and data, Oscar provides easy-to-understand bills, 24/7 access to doctors, and a p...

Insurance
1K-5K
Founded 2012

Description

  • Develop and maintain expertise in CPT, HCPCS, and ICD-10 coding guidelines and other insurance billing submission requirements.
  • Perform detailed prepayment and post-payment audits of medical records and claims to verify claim accuracy.
  • Document audit findings clearly with source references so they can be understood by non-clinicians and coders.
  • Create reports and reference guides to help teammates communicate findings and conduct similar reviews more effectively.
  • Draft written communications to providers to explain audit findings.
  • Participate in educational calls with providers.
  • Assist in training new team members.
  • Develop and document process improvements to increase team efficiency and effectiveness.
  • Support root cause analysis and issue resolution in the claims environment.
  • Comply with all applicable laws and regulations.

Requirements

  • 1+ years of coding or auditing experience across multiple specialties.
  • Certified Professional Coder (CPC) designation or similar certification.
  • Bachelor's degree or 4+ years of work experience.
  • Experience working in health insurance with claims processing, billing, reimbursement, or provider contracting.
  • Preferred: Certified Professional Medical Auditor.
  • Preferred: Payment Integrity audit experience.
  • Preferred: Experience translating technical jargon for non-technical audiences.
  • Preferred: Experience with HIPAA, data privacy, and/or data security processes.
  • Preferred: Experience working with regulators overseeing public or private health insurance carriers.

Benefits

  • Base pay of $65,412-$85,853 per year in New York City or $58,870-$77,267 per year in other locations.
  • Eligible for Oscar's unlimited vacation program.
  • Eligible for annual performance bonuses.
  • Medical, dental, and vision insurance.
  • 11 paid holidays.
  • Paid sick time and paid parental leave.
  • 401(k) plan participation.
  • Life and disability insurance.
  • Paid wellness time and reimbursements.

Interested in this position?

Apply directly on the company website

Apply Now

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