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

The Manager, Payment Integrity leads a team tasked with tactical and strategic initiatives with the goal of improving overall payment integrity solutions, processes, and performance. The Manager plays a critical role in the overall claims improvement apparatus by providing leadership, structure and organization, enabling the team to succeed.

You will report to the Vice President, 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.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $103,200 - $135,450 per year. The base pay for this role in all other locations is: $92,880 - $121,905 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

Be the subject matter expert for Payment Integrity operations through knowledge and expertise of Oscar’s claim platform, claim regulatory requirements and operational workflows.
Ensures payment integrity processes are in compliance with Federal and state regulatory and contractual requirements.
Oversees Payment Integrity projects and implementations with a focus on building scalable processes for vendor engagements.
Effectively uses business intelligence and data analytics to monitor operations and identify cross functional process improvement opportunities.
Ensures payment integrity productivity aligned to financial and quality targets.
Develop, implement, and maintain payment integrity policies and procedures.
Manage a complex portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators
Develop team workflows and guidelines that produce consistent and measurable outcomes; train, teach and mentor team members to become more proficient and effective.
Compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

A bachelor’s degree or 4+ years of commensurate experience
4+ years experience in operations, healthcare, data analytics, engineering and/or consulting
4+ years of experience analyzing data to solve complex business problems
2+ years of experience in payment integrity
2+ years of experience leading and developing a team
2+ years experience designing, implementing and improving business workflows
Proficiency in medical terminology, medical coding (CPT4, ICD9 or ICD10, and HCPCS), provider contract concepts and common claims processing/resolution practices
Experience with reimbursement methodologies
Ability to execute on multiple high priority projects within tight deadlines

Bonus Points

Process Improvement or Lean Six Sigma training, certification
Experience with healthcare claims processing
Experience managing in a healthcare claims organization
Experience with SQL and basic SQL abilities
Experience with claims editing software such as ClaimsXten, Cotiviti, Optum
Payment Integrity experience prepay and/or post-pay
Extensive knowledge of Medical, Behavioral Health, Dental and Pharmacy billing and coding
Ability to take complex ideas and processes and communicate them in a clear and concise manner

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.

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