Senior Manager, Payment Integrity

Posted 13 days agoViewed

💎 Seniority level: Manager, 6+ years

📍 Location: 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, or Washington, D.C.

💸 Salary: 107280.0 - 156450.0 USD per year

🔍 Industry: Healthcare

🏢 Company: Oscar Health👥 1001-5000💰 $140,000,000 Private over 4 years ago🫂 Last layoff almost 5 years agoHealth Insurance InsurTech Insurance Health Care

🗣️ Languages: English

⏳ Experience: 6+ years

🪄 Skills: LeadershipSQLData AnalysisPeople ManagementCross-functional Team LeadershipComplianceProcess improvementData analytics

Requirements:

6+ years experience in operations, healthcare, data analytics and/or consulting
6+ years of experience analyzing data to solve complex business problems
3+ years of experience leading and developing a team
3+ years experience designing, implementing and improving business workflows
6+ years experience in medical coding
Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)
Expert level experience with reimbursement methodologies, provider contract concepts and common claims processing/resolution practices.

Responsibilities:

Be the subject matter expert for Payment Integrity policies and claims processing edits through knowledge and expertise of Oscar’s claim platform, claim coding and regulatory requirements and operational workflows.
Anticipate, overcome, and prevent recurrence of complex problems and roadblocks in an efficient and effective manner
Create routines that drive cross-functional collaboration within and outside of department
Develop and implement standard Payment Integrity policies, procedures and workflows
Drive ideation of payment integrity opportunities
Manage inquiries related to Oscar edits & disputes
Monitor performance of Oscar edits, including but not limited to monthly quality audits.
Participate in governance committee activities to ensure alignment with internal stakeholders & business decisions.
Translate a strategic vision for the team and outline clear and measurable performance metrics / OKRs.
Coach, develop and lead a team to achieve identified outcomes.
Provide leadership in complex, cross-functional initiatives focused on claims improvement.
Manage a portfolio of initiatives and deliverables and proactively identify areas of opportunity to improve key performance indicators.
Compliance with all applicable laws and regulations
Other duties as assigned

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