Senior Manager, Payment Integrity (Chart Review)

Hi, we're Oscar. We're hiring a Senior Manager, Chart Review to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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 Senior Manager, Chart Review leads and oversees Oscar's internal pre-payment chart review program, setting and holding the team accountable to performance, and develops strategic plans to achieve outcomes. The Senior Manager plays a critical role in the overall claims improvement apparatus by providing leadership, structure and organization, including coaching and developing direct reports, in order to enable the team's success. This person supports our teams in driving a best-in-class, service-focused operation by designing, guiding and assessing the effectiveness of the use of operational frameworks and ideologies.

You will report into the Vice President, Payment Integrity.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia; Chicago, Illinois; Dallas, Texas; Louisville, Kentucky; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Salt Lake City, Utah. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $111,034 - $145,733 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Lead, oversee, and grow Oscar's internal pre-payment chart review program.

• Lead a team to efficiently manage production inventory issues, ensuring achievement of production and quality targets.

• Anticipate, overcome, and prevent recurrence of complex problems and roadblocks in an efficient and effective manner.

• Establish routines that foster cross-functional collaboration with technology and data science teams to enhance chart review Key Performance Indicators (KPIs): hit rate, change rate, and other productivity metrics.

• Develop and implement standard Payment Integrity policies and procedures

• Drive ideation of payment integrity opportunities

• 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 / KPIs.

• 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

Requirements:

• 6+ years experience in operations, data analytics and/or consulting within healthcare

• 6+ years of experience analyzing data to solve complex operational business problems

• 3+ years of experience leading an operations production team

• 3+ years experience designing, implementing and improving business workflows

• Ability to execute on multiple high priority projects within tight deadlines

Bonus points:

• Medical coding certification through AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA)

• Process Improvement or Lean Six Sigma training, certification

• Experience with healthcare claims processing

• Experience managing in a healthcare claims organization

• Experience using SQL

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.

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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 ([email protected]) to make the need for an accommodation known.

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