Role Description Hi, we're Oscar. We're hiring a Senior Specialist, Coding Auditor to join our Payment Integrity. You will support issue resolution in the Oscar claim environment. You will be responsible for the end-to-end claims repayment quality, process improvement, and supporting root cause analysis. You will report into the VP, Payment Integrity. Work Location: - This is a remote position, open to candidates who reside in: - Tempe, Arizona - Atlanta, Georgia - Chicago, Illinois - Dallas, Texas - Louisville, Kentucky - Minneapolis, Minnesota - New York City, New York - Philadelphia, Pennsylvania - Salt Lake City, Utah - While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency: - The base pay for this role in New York City is: $65,412 - $85,853 per year. - The base pay for this role in all other locations is: $58,870 - $77,267 per year. - You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses. Responsibilities - Develop and maintain a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements. - Efficiently perform thorough and 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. - Explicitly 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. - Assist in drafting written communications to providers to convey findings. - Participate in educational calls with providers. - Assist in the training of new team members. - Develop and document processes to improve the efficiency and effectiveness of the team. - Compliance with all applicable laws and regulations. - Other duties as assigned. Qualifications - 1+ years of coding or auditing experience across multiple specialties. - Certified Professional Coder (CPC) designation or similar certification. - Bachelor's degree or 4+ years of work experience. - Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting. Requirements - Bonus points: - Certified Professional Medical Auditor. - Payment Integrity audit experience. - Demonstrated experience translating technical jargon to non-technical end users. - Experience with HIPAA, data privacy, and/or data security processes. - Experience working with regulators governing (public or private) health insurance carriers. Benefits - 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. - Paid wellness time and reimbursements.