Key skills
Decision Making
About this role
Role Overview
- Perform quality checks of other team members' coding audit reviews and deliver in written or verbal form to ensure accuracy and compliance with coding standards and Oscar policy.
- Review dashboards and interpret performance data in support of production goals; Recommend response and inform management before deadlines are missed.
- Identify and help develop new processes to ensure efficient and effective audit functions.
- Perform complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.
- Explicitly document findings including sources used to support decision making and in a way that can be easily understood by non clinicians or coders.
- Participate in educational calls or written communications to articulate findings to providers under SIU review.
- Facilitate team and cross-team education
- Compliance with all applicable laws and regulations
Requirements
- Bachelor's degree or equivalent years of experience
- Certified Professional Coder (CPC) designation or similar
- 3+ years of coding or auditing experience across multiple specialties.
Benefits
- employee benefits
- participation in Oscar's unlimited vacation program
- annual performance bonuses