Senior Manager, Payment Integrity - job 1 of 2

As the Senior Manager, Payment Integrity at Oscar, your primary responsibilities will include identifying and prioritizing claims improvement opportunities, leading teams towards performance accountability, and developing strategic plans for achieving payment integrity outcomes. You’ll serve as the subject matter expert on Payment Integrity policies and facilitate smooth collaboration across departments, ensuring that operational workflows are both efficient and effective.

Candidates for the Senior Manager, Payment Integrity position at Oscar should have at least 6 years of experience in operations, healthcare, data analytics, or consulting. A background in medical coding is essential, along with a relevant certification from AAPC or AHIMA. Additionally, experience in leading and developing teams, as well as expertise in reimbursement methodologies and claims processing practices, is highly beneficial for this role.

Oscar defines success for the Senior Manager, Payment Integrity by setting clear and measurable performance metrics, such as OKRs, and by driving a culture of continuous improvement. Success in this role involves coaching and developing your team effectively, managing complex initiatives, and fostering cross-functional collaboration to achieve desired claims improvement outcomes.

At Oscar, the work culture is characterized by a blended environment that promotes connection and community, regardless of whether you’re working remotely or in the office. As a Senior Manager, Payment Integrity, you will experience a supportive atmosphere focused on collaboration, innovation, and inclusivity, allowing all employees to thrive and contribute towards Oscar's mission.

As a Senior Manager, Payment Integrity at Oscar, you'll have ample opportunities for professional growth, including access to training programs, leadership development initiatives, and participation in strategic projects. Oscar encourages continuous learning, allowing you to expand your skills in healthcare analytics, operational management, and people leadership to advance your career.

In my previous roles, I focused significantly on claims processing, where I developed strong skills in identifying discrepancies and implementing resolution strategies. I have hands-on experience with payment integrity policies and have worked closely with various teams to streamline workflows, enhance performance, and ensure compliance with regulations.

In my role, I prioritize tasks by evaluating their impact on overall performance metrics and business objectives. I utilize project management tools to assess urgency and importance while collaborating with my team to ensure alignment on priorities, enabling us to meet deadlines and achieve our goals effectively.

To foster teamwork, I encourage open communication and regular check-ins to identify roadblocks and share updates. Implementing collaborative tools and hosting brainstorming sessions enhances engagement and creativity while aligning everyone’s efforts towards achieving common objectives.

When facing conflicts with stakeholders, I approach the situation with transparency and empathy, striving to understand their perspectives. I aim to provide data-backed insights and facilitate open discussions that lead to collaborative solutions, ensuring all parties feel heard and valued.

Certainly! In my last position, I led an initiative where I analyzed the claims processing workflow to identify bottlenecks. By redesigning the process and implementing automation for routine tasks, we reduced processing time by 30%, significantly improving the team's efficiency and accuracy.

Data analytics are vital in enhancing payment integrity as they provide insights into claim patterns, identify discrepancies, and highlight areas for improvement. By analyzing data, I can develop targeted strategies to address issues, refine workflows, and ultimately improve financial outcomes for the organization.

I prioritize staying current with healthcare regulations by subscribing to industry newsletters, attending webinars, and participating in professional organizations. This proactive approach allows me to adapt promptly to changes, ensuring compliance and maintaining best practices in claims processing.

My leadership style is collaborative and supportive, focusing on empowering team members by providing guidance and tools for development. I believe in setting clear expectations and fostering an environment where feedback is encouraged, enabling the team to thrive and succeed collectively.

Essential metrics for measuring payment integrity include claims accuracy rates, the percentage of resolved disputes, turnaround time for processing claims, and compliance adherence levels. Regularly monitoring these metrics helps identify trends and areas for improvement to enhance the entire claims management process.

I am drawn to the opportunity at Oscar because of its commitment to innovation and improving healthcare for its members. I resonate with the mission and values of Oscar, and I believe my skills in payment integrity and team leadership align perfectly with the goals of this role, making it an ideal fit for contributing to meaningful change.