SIU Coding Auditor

1 month ago
Full-time
Mid Level
Operations
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

  • Perform quality checks of other team members’ coding audit reviews and communicate findings in written or verbal form to ensure accuracy and compliance with coding standards and Oscar policy.
  • Review dashboards and interpret performance data to support production goals, recommend responses, and alert management before deadlines are missed.
  • Perform complex reviews of medical records and claims on both a prepayment and post-payment basis to determine accuracy of claims submitted to Oscar.
  • Explicitly document audit findings, including sources used to support decisions, in clear language understandable to non-clinicians and non-coders.
  • Participate in educational calls and written communications to articulate findings to providers under SIU review.
  • Facilitate team and cross-team education to share audit learnings and improve processes.
  • Identify and help develop new processes, policies, and procedures to improve the efficiency and effectiveness of audit functions.
  • Ensure compliance with applicable laws and regulations while supporting operational and financial anti-fraud targets.

Requirements

  • Bachelor’s degree or equivalent years of experience.
  • Certified Professional Coder (CPC) designation or similar coding certification.
  • 3+ years of coding or auditing experience across multiple specialties.
  • Residency in Arizona, Florida, Georgia, or Texas (role is remote and limited to these states).
  • Ability to travel occasionally for team meetings and company events.
  • Strong documentation skills to record findings and sources in an audit-ready format.
  • Preferred: Certified Professional Medical Auditor (CPMA) or other coding certifications.
  • Preferred: Certifications related to fraud investigations such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or Certified AML and Fraud Professional (CAFP).
  • Preferred: Knowledge of applicable fraud statutes, federal guidelines on recoupments/anti-FWA activity, HIPAA, data privacy/data security, and experience interacting with health insurance regulators.

Benefits

  • Base pay range $75,265–$98,785 per year plus eligibility for annual performance bonuses.
  • Eligible for medical, dental, and vision benefits.
  • Participation in Oscar’s unlimited vacation program, 11 paid holidays, and paid sick time.
  • Paid parental leave.
  • 401(k) plan participation.
  • Life and disability insurance.
  • Paid wellness time and wellness reimbursements.
  • Remote work (role is remote for candidates residing in AZ, FL, GA, or TX) with occasional travel for team meetings/events.

Interested in this position?

Apply directly on the company website

Apply Now

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