Senior Specialist, Coding Auditor
Senior Specialist, Coding Auditor
Senior Specialist, Coding Auditor
Oscar Health
Oscar is a health insurance company focused on leveraging technology to enhance member services. They are seeking a Senior Specialist, Coding Auditor to join their Special Investigation Unit (SIU) to analyze trends in fraud, waste, and abuse (FWA) in healthcare, utilizing deep coding knowledge to prevent and recover improperly paid claims.
Qualification
- Deep knowledge of coding guidelines (CPT, HCPCS, ICD-10).
- Experience in auditing medical records and claims.
- Ability to document findings clearly and effectively.
- Understanding of fraud, waste, and abuse in healthcare.
- Strong analytical skills to assess trends and patterns in claims data.
Responsibility
- Develop expertise in CPT, HCPCS, and ICD-10 Coding guidelines and insurance billing requirements.
- Perform complex audits of medical records and claims on prepayment and post-payment basis.
- Document findings clearly for non-clinicians and coders, referencing sources used for decision making.
- Support the SIU in assessing trends and patterns in FWA across the healthcare industry.
- Coordinate activities to reduce the incidence and impact of FWA on operations.
