Develop a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements.
Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.
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 audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews.
Help draft written communications to providers to convey audit findings.
Participate in educational calls with providers.
Help train new team members.
Develop and document processes to improve the effectiveness of the team.
Compliance with all applicable laws and regulations
Other duties as assigned

2+ years of coding or auditing experience across multiple specialties is required
Bachelor's degree or 4+ years of work experience
Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification
Experience working in production-based environment
Experience of both outpatient and inpatient auditing

Senior Specialist, Coding Auditor

Key skills