Medical Coding Audit Manager

Job Description

Hi, we're Oscar. We’re hiring an Medical Coding Audit Manager to join our Insurance Operations team.

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:

Insurance Operations powers some of the fastest scaling operations that are required to run an insurance company: processing claims (including ensuring payment integrity), large-scale provider contracting, member and provider data ingestion, and more. As we continue to scale our operations, we’re looking for experienced team members to help drive the effort.

When you come in, you will support a team responsible for building outstanding processes and collaborating with partners across several departments, such as Data, Clinical, Legal, and Compliance. You will provide interdepartmental leadership on appropriate medical coding and billing norms, which will enable Oscar to develop foundational processes to scale our fraud, waste, and abuse (FWA) program. The outcomes your team provides will propel Oscar’s priorities and have a lasting impact on our ability to provide affordable health care to all our members.

You will report into the Manager of Insurance Operations in New York City.

Responsibilities:

• Manage and hire team of medical coding auditors
• Review claims / medical records to determine validity of payment due to potential fraudulent, wasteful, and abusive care
• Communicate review findings internally with FWA and Special Investigation Unit (SIU) teams
• Conduct clear documentation of inconsistencies with claims billed vs health plan payments
• Provide subject matter expertise on FWA cases (including medical chart review)
• Train team members and key stakeholders on appropriate coding and billing norms
• Identify and recommend opportunities for process improvements (including tools and systems) to help us work smarter
• Manage high priority projects simultaneously while maintaining production standards

Requirements:

• 5+ years of medical coding experience with at least 3 of those years doing Medical Code Auditing
• 2+ experience managing direct reports
• Professional certification in medical coding (CPC)
• Proficiency in medical/claims terminology as well as CPT, HCPCS, ICD-10
• Knowledge auditing coding for E&M, CPT codes, diagnosis codes, procedure codes, modifiers, and billing edits
• Experience in fraud, waste, and abuse

Bonus points:

• Proficiency in DRG coding is a plus
• Exposure to payment integrity and payment policy optimization

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, unlimited 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 .