Oscar Health is looking for an SIU Coding Auditor to join our Special Investigation Unit (SIU). In this role, you will leverage your deep coding knowledge to assess trends in fraud, waste, and abuse (FWA) across the healthcare industry, helping to prevent and recoup inappropriately paid claims. You will be a key part of coordinating activities across Oscar to reduce the impact of FWA on our operations.
What You'll Do
- 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.
- Document findings clearly, including references to sources, for non-clinical or non-coding audiences.
- Create audit report findings, tools, and reference guides for team use.
- 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 team effectiveness.
- Ensure compliance with all applicable laws and regulations.
What We're Looking For
- 2+ years of coding or auditing experience across multiple specialties.
- 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 a production-based environment.
- Experience with both outpatient and inpatient auditing.
Nice to Have
- Certified Professional Medical Auditor (CPMA) certification.
- Additional certifications such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or Certified AML and Fraud Professional (CAFP).
- Knowledge of applicable fraud statutes, federal guidelines on recoupments, and other anti-FWA activity.
- Demonstrated experience translating technical jargon to non-technical end users.
- Experience in health insurance with claims processing, billing, reimbursement, or provider contracting.
- Experience with HIPAA, data privacy, and/or data security processes.
- Experience working with regulators governing health insurance carriers.
Team & Environment
You will report to the Manager, SIU Coding Audit as part of the Special Investigation Unit.
Benefits & Compensation
- Comprehensive employee benefits package.
- Participation in Oscar's unlimited vacation program.
- Annual performance bonuses.
- 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.
- Base pay for this role in California, Connecticut, New Jersey, New York, and Washington: $63,200 - $82,950 per year.
- Base pay for this role in all other locations: $56,880 - $74,655 per year.
Work Mode
This is a hybrid position open to candidates located in: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, 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, and Washington, D.C.
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.
