[Hiring] Clinical Coding Auditor @Oscar

Hello, we are Oscar. We are hiring a Clinical Coding Auditor, SIU, to sign up for our SIU crew.

Oscar is the primary medical health insurance corporate constructed round a complete stack generation platform and a focal point on serving our individuals. We began Oscar in 2012 to create the type of medical health insurance corporate we would wish for ourselves—person who behaves like a physician within the circle of relatives.

Concerning the position

The Senior Specialist, Clinical Coding Auditor, SIU, works to reinforce in assessing traits and patterns in FWA around the healthcare business the use of deep coding wisdom to audit prepayment and/or put up cost claims. The Senior Specialist runs and coordinates actions throughout Oscar to cut back the occurrence and impact of fraud, waste, and/or abuse (“FWA”) on all our operations.

You are going to report back to the Coding Audit Supervisor, SIU.

Paintings Location:

Oscar is a combined paintings tradition the place everybody, without reference to paintings kind or location, feels attached to their teammates, our tradition and our challenge.

In the event you reside inside of commutable distance to our New York Town place of business (in Hudson Sq.), our Tempe place of business (off the 101 at College Dr), or our Los Angeles place of business (in Marina Del Rey), you’re going to be anticipated to come back into the place of business no less than two days every week. Another way, it is a far flung / work-from-home position.

You should live in one of the vital following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Notice, this checklist of states is matter to modify. #LI-Far off

Pay Transparency:

The bottom pay for this position within the states of California, Connecticut, New Jersey, New York, and Washington is: $63,200 – $82,950 consistent with yr. The bottom pay for this position in all different places is: $56,880 – $74,655 consistent with yr.  You’re additionally eligible for worker advantages, participation in Oscar’s limitless holiday program and annual efficiency bonuses.

Obligations

• Develops and maintains a intensity of experience on CPT, HCPCS, and ICD-10 Coding tips and different insurance coverage billing submission necessities.
• Carry out complicated coverage updates or audits of assigned documentation (i.e. clinical data or claims) on each a prepayment and/or put up cost foundation to decide accuracy of claims submitted to Oscar.
• Record findings together with connection with assets used to reinforce resolution making and in some way that may be simply understood by means of non clinicians or coders.
• Create studies and reference guides that can be utilized by means of different crew individuals to be in contact findings or extra successfully carry out an identical critiques.
• Lend a hand draft written communications to suppliers to put across findings.
• Take part in tutorial calls with suppliers.
• Lend a hand teach new crew individuals.
• Increase and report processes to enhance the effectiveness of the crew.
• Compliance with all appropriate regulations and rules
• Different tasks as assigned

{Qualifications}

• 1+ years of coding or auditing revel in throughout more than one specialties.
• Bachelor’s level or 4+ years of labor revel in

Bonus Issues

• Qualified Skilled Coder (CPC) designation or an identical certification (required for SIU)
• Qualified Skilled Clinical Auditor
• Further certification appropriate to this paintings similar to Qualified Fraud Examiner (CFE), Authorised Healthcare Fraud Investigator (AHFI), Qualified AML [Anti-Money Laundering] and Fraud Skilled (CAFP), different coding certifications or an identical
• Wisdom of appropriate fraud statutes and rules, and of federal tips on recoupments and different anti-FWA task
• Demonstrated revel in translating technical jargon to non-technical finish customers.
• Enjoy running in medical health insurance particularly with claims processing, billing, repayment, or supplier contracting.
• Enjoy with HIPAA, knowledge privateness, and/or knowledge safety processes
• Enjoy running with regulators governing (public or non-public) medical health insurance carriers