Senior Manager, Payment Integrity

Hi, we're Oscar. We're hiring a Senior Manager, Payment Integrity to join our Payment Integrity team. Oscar is the first health insurance company built around a full stack technology platform and a 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, Payment Integrity identifies and prioritizes claims improvement opportunities, sets and holds teams accountable to performance, and develops strategic plans to achieve overall payment integrity 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 and their teams, 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 to the Senior Director, Payment Integrity. Work Location: Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. You must reside in one of the following states: 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. Note, this list of states is subject to change. #LI-Remote Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $119,200 - $156,450 per year. The base pay for this role in all other locations is: $107,280 - $140,805 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses. 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 Qualifications • 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. Bonus Points • Process Improvement or Lean Six Sigma training, certification • Experience managing in a healthcare claims organization • Experience using SQL Apply Job!