Medical Coding Auditor

Job Description

Hi, we're Oscar. We’re hiring a Medical Coding Auditor 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:

When you come in, you will do crucial medical auditing on appropriate coding and billing norms, which will enable Oscar to scale the fraud, waste, and abuse (FWA) program. These outcomes will propel Oscar’s priorities and will have a lasting impact on our ability to provide affordable health care to all our members.

You will report into the Associate Operations Manager, Medical Coding.

You will:

• Review claims / medical records to determine validity of payment due to potential fraudulent, wasteful, and abusive care
• Communicate review findings internally with FWA and 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 Auditing
• Professional certification in medical coding (CPC or CCS)
• 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
• E xposure to payment integrity and payment policy optimization

Life at Oscar:

Our more than 1,000 employees aim to make health care affordable and accessible for all. We 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.

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 your unique background and perspectives.

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 .