Senior Manager, Clinical Practice Compliance

Job Description

Hi, we're Oscar. We’re hiring a Senior Manager, Clinical Practice Compliance to join our Oscar Medical Group team in our New York office.

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health insurance simple, transparent, and human. We need your help to do so.

About the role:

Oscar Medical Group is looking for an experienced clinical practice Compliance Sr Manager to support the telehealth practice’s growth and ensure that our members continue to receive the high-quality care they deserve. You will own the end-to-end Compliance and Oversight processes for our providers.

The Compliance Sr. Manager should have knowledge in many areas, including business administration, clinical activities, coding, billing, reimbursement, risk management, and strong familiarity with the laws and regulations applicable to telehealth practices. They must exercise good judgment, prioritize thoughtfully, and - to foster the necessary culture - be approachable.

You will report into the Director, Practice Transformation & Operations

Responsibilities:

• Design and own the practice compliance and provider quality processes, especially processes related to HIPAA and state-specific regulations pertaining to telehealth.
• Design and build new processes/systems as needed for provider entities’ billing practices with respect to government payors.
• Support the provider entities’ entry into new states and markets by ensuring preparedness and compliance with applicable clinical practice and telehealth regulations.
• Develop, coordinate, and if necessary conduct practice compliance training programs for practice staff. Manage maintenance and audit compliance training records
• Develop policies and processes for reporting non-compliance issues, including management of the compliance reporting process for all persons associated with the practice.
• Track and maintain records related to compliance plans, including audit documentation, training resources for practice personnel and agents, screening results, reports of suspected or actual noncompliance, investigations reports and records, and all corrective action plans.
• Manage the practice compliance budget.

Requirements:

• College degree
• 6+ years’ of relevant experience (e.g., provider-side compliance, telehealth management, practice management, quality setting)
• Experience with regulatory bodies and knowledge of HIPAA and data privacy
• Knowledge of telehealth, provider-side compliance, and a desire to build a culture of compliance and ethics.

Bonus points:

• Applicable health care and/or compliance certifications (e.g., AAPC/ CPPM, CPCO; HCCA/CHC; HTE/CCP; SCCE/CCEP)
• Managerial experience
• Experience with billing government payors, including Medicare Advantage, and coordination of benefits
• Strong design to tackle the challenges (and opportunities) posed by telemedicine/health

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 encourage our members to care for their whole selves, and we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here .