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SalaryHi, we're Oscar. We're hiring a Senior Analyst, Coding to join our Payment Integrity team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role
This role is responsible for supporting accurate and timely medical claims coding updates across reimbursement policy and payment integrity solutions. The Senior Analyst, Coding role organizes, scopes, triages, investigates and/or executes on solutions and process improvements. This is accomplished by leveraging a deep understanding of Oscar's claim infrastructure and workflows combined with subject matter expertise regarding medical coding guidelines and terminology.
You will report to the Senior Director, Payment Integrity.
Work Location:
Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.
If you live within commutable distance to our New York City office ( in Hudson Square), our Tempe office (off the 101 at University Ave), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.
This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $63,200 - $82,950 per year. The base pay for this role in all other locations is: $56,880 - $74,655 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities
- Manage CPT / HCPC and other CMS/AMA coding updates on a quarterly basis or more frequently has needed
- Reconcile updated coding to pre-pay claims edits
- Ensure updated coding is shared with matrix partners: configuration, reimbursement policy, clinical policy, etc.
- Support resolution of coding inquiries and disputes
- Participate in coding audits or testing for tracking system performance relative to coding updates
- Use insights from vendor edits, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems
- Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate
- Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- A bachelor's degree or 4+ years of commensurate experience
- Extensive knowledge of coding guidelines and reimbursement methodologies
- 1+ years experience deriving business insights from datasets and solving problems
- 1+ years experience improving business workflows and processes
- 1+ years experience collaborating with internal and/or external stakeholders
- Certified professional coder or other clinical credentials
Bonus Points
- An academic and/or professional background in healthcare with specialty in coding
- Experience in a professional healthcare claims organization
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
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..
Pay Transparency:
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.
Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
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 (accommodations@hioscar.com) to make the need for an accommodation known.
