Manager, SIU Coding Audit Post-Pay

As the Manager, SIU Coding Audit Post-Pay at Oscar, you will oversee a team dedicated to conducting both prepayment and post-payment reviews of medical records and claims. Your responsibilities will include managing performance metrics, providing insights into operational efficiencies, and leading the quality review process. You will also communicate findings to providers, ensuring that all coding standards are met and maintained.

To qualify for the Manager, SIU Coding Audit Post-Pay role at Oscar, candidates must possess a Bachelor’s degree along with a minimum of 5 years of coding experience, including at least 3 years in auditing across multiple specialties. A Certified Professional Coder (CPC) designation is essential, along with 2+ years of experience managing direct reports. Additional certifications in fraud investigation and knowledge of relevant regulations can enhance your application.

Yes! The Manager, SIU Coding Audit Post-Pay position at Oscar is primarily remote, allowing for flexibility in your work setup. However, if you reside within commuting distance of our offices in New York City, Los Angeles, or Tempe, you are expected to be in the office at least two days a week. This blended approach fosters connection with your teammates and upholds our vibrant company culture.

Working as a Manager, SIU Coding Audit Post-Pay at Oscar is an opportunity to be at the forefront of a mission-driven company dedicated to changing health care for the better. You’ll work alongside a supportive team, have the chance to lead, innovate, and cultivate your own professional growth, all while contributing to a robust anti-fraud program that significantly impacts our members’ experience.

The salary for the Manager, SIU Coding Audit Post-Pay position at Oscar varies depending on location. For those in California, Connecticut, New Jersey, New York, and Washington, the pay range is approximately $98,400 to $129,150 per year. In other states, the range is between $82,240 and $110,565 per year, complemented by comprehensive employee benefits and performance bonuses.

To ensure accuracy in coding audits, I employ a systematic approach that includes thorough reviews of medical records and strong collaboration with other team members. I focus on adhering to coding guidelines, maintaining clear documentation of findings, and communicating effectively to clarify any discrepancies, ultimately helping uphold high standards for accuracy.

Leading a coding audit team effectively involves setting clear performance metrics, fostering open communication, and providing continuous feedback. I prioritize creating an engaging work environment that encourages innovation and collaboration, allowing team members to voice their ideas and concerns while developing their skills and understanding of coding standards.

I have a strong background in ensuring compliance with coding regulations and guidelines. My experience includes staying informed on updates from relevant regulatory bodies, implementing auditing processes that align with compliance standards, and training my team on best practices to avoid potential violations and mitigate risks to the organization.

When discrepancies arise in coding findings, I prioritize thorough investigation and analysis of the relevant medical records or claims. Engaging in constructive discussions with my team helps identify root causes. I ensure all findings are well-documented, facilitating informed decisions and communicating transparently with stakeholders involved.

Technology is integral to my auditing process. I use advanced coding software and data analytics tools to enhance efficiency, accuracy, and transparency in audits. These technologies enable us to track performance metrics and streamline communication within the team while helping us identify patterns that may indicate potential fraud more effectively.

I stay current with developments in coding and fraud regulations by participating in ongoing education, attending workshops, and networking with industry professionals. Subscribing to relevant newsletters and joining professional organizations also helps me stay informed about updates that affect coding practices and compliance standards.

A successful coding audit program combines a clear strategic framework, strong leadership, and continuous training for audit staff. Moreover, integrating effective communication channels, leveraging technology, and regularly reviewing program outcomes to implement improvements is essential for maintaining the program's integrity and effectiveness.

Throughout my career, I've emphasized team development and mentorship by investing time in cultivating individual strengths and guiding team members towards their career aspirations. Conducting regular one-on-one check-ins, providing constructive feedback, and facilitating training sessions contribute to building confidence and competence within the team.

Maintaining quality assurance in auditing involves implementing structured review processes, actively monitoring audit performance against set benchmarks, and encouraging peer reviews. I prioritize a quality control mindset where team members are trained to focus on accuracy, compliance and to continuously refine their auditing skills throughout their tenure.

Dealing with a teammate who consistently misses performance targets requires a supportive approach. I would first initiate a private conversation to understand any challenges they may be facing. Together, we would identify areas for improvement and develop a structured plan to provide the necessary support, resources, or training to help them succeed.