Full-Time

Medical Coding Auditor

Siu

Posted on 9/23/2024

Oscar Health

Oscar Health

1,001-5,000 employees

Health insurance provider using technology

Fintech
Healthcare

Compensation Overview

$56.9k - $83kAnnually

+ Annual Performance Bonuses

Junior, Mid

Los Angeles, CA, USA + 3 more

More locations: Remote in USA | Tempe, AZ, USA | New York, NY, USA

Hybrid role for candidates within commutable distance to New York City, Tempe, or Los Angeles; otherwise, remote.

Category
Diagnostics & Laboratory Professionals
Healthcare Administration & Support
Medical, Clinical & Veterinary
Requirements
  • 1+ years of coding or auditing experience across multiple specialties.
  • Bachelor’s degree or 4+ years of work experience.
  • Certified Professional Coder (CPC) designation or similar certification (required for SIU).
  • Certified Professional Medical Auditor.
  • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar.
  • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity.
  • Demonstrated experience translating technical jargon to non-technical end users.
  • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting.
  • Experience with HIPAA, data privacy, and/or data security processes.
  • Experience working with regulators governing (public or private) health insurance carriers.
Responsibilities
  • Develops and maintains a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.
  • Perform complex policy updates or audits of assigned documentation (i.e. medical records or claims) on both a prepayment and/or post payment basis to determine accuracy of claims submitted to Oscar.
  • Document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders.
  • Create reports and reference guides that can be used by other team members to communicate findings or more effectively perform similar reviews.
  • Help draft written communications to providers to convey findings.
  • Participate in educational calls with providers.
  • Help train new team members.
  • Develop and document processes to improve the effectiveness of the team.
  • Compliance with all applicable laws and regulations.
  • Other duties as assigned.

Oscar Health provides health insurance plans for individuals, families, and small businesses, aiming to simplify the insurance experience through technology. Their services include 24/7 virtual care, allowing members to consult healthcare providers anytime, which is convenient for those needing immediate medical advice. Oscar also offers tools to help members locate doctors and facilities that accept their insurance, enhancing access to care. Unlike traditional insurers, Oscar focuses on user engagement and digital accessibility, ensuring their services are inclusive for all, including people with disabilities. The company's goal is to make healthcare more accessible and affordable while maintaining high-quality care.

Company Stage

IPO

Total Funding

$1.6B

Headquarters

New York City, New York

Founded

2012

Growth & Insights
Headcount

6 month growth

4%

1 year growth

11%

2 year growth

9%
Simplify Jobs

Simplify's Take

What believers are saying

  • Oscar Health's partnership with Cigna expands its provider network for small businesses.
  • The company gained 600,000 new members through personalized digital campaigns in 2023.
  • Oscar Health reported a 46% revenue increase year-over-year, showcasing strong financial performance.

What critics are saying

  • Oscar Health exited the Medicare Advantage market, losing 1,800 members.
  • The partnership with Cigna saw a membership decline of nearly 10,000 members year-over-year.
  • Reliance on the ACA market poses risks due to potential political and regulatory changes.

What makes Oscar Health unique

  • Oscar Health uses technology to simplify and humanize the insurance experience.
  • The company offers 24/7 virtual care services for immediate medical consultations.
  • Oscar Health focuses on digital accessibility, ensuring services are inclusive for all.

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Benefits

Health insurance - That’s a given. Employees and their families receive incredible health insurance.

Financial benefits - A penny saved....we’re talking about a 401K plan, health savings accounts, and more.

Well @ Oscar - We care about your wellness with fitness classes and access to mental health support.

Work-Life Balance - We offer multiple time-off options, wellness days, and 10+ weeks of parental leave.

Learning & Development - We offer everything from mentorship to management training.

INACTIVE