Oscar Health · 1 day ago
Senior Specialist, Coding Auditor
New York, New York, United States
Full-time
Hybrid
Mid, Senior Level
$63K/yr - $83K/yr
2+ years expOscar is a health insurance company focused on leveraging technology to serve its members. The Senior Specialist in Coding Audit will support the Special Investigation Unit by assessing trends in fraud, waste, and abuse in healthcare, utilizing coding expertise to prevent and recover improperly paid claims.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Develop a depth of expertise on CPT, HCPCS, and ICD-10 Coding guidelines and other insurance billing submission requirements
Perform complex audits of assigned medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar
Document findings including reference to sources used to support decision making and in a way that can be easily understood by non clinicians or coders
Create audit report findings, tools, and reference guide that can be used by other team members to communicate findings or more effectively perform similar reviews
Help draft written communications to providers to convey audit findings
Participate in educational calls with providers
Help train new team members
Develop and document processes to improve the effectiveness of the team
Compliance with all applicable laws and regulations
Other duties as assigned
Qualification
Required
2+ years of coding or auditing experience across multiple specialties is required
Bachelor's degree or 4+ years of work experience
Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC) designation or similar certification
Experience working in production-based environment
Experience of both outpatient and inpatient auditing
Preferred
Certified Professional Medical Auditor (CPMA)
Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), other coding certifications or similar
Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity
Demonstrated experience translating technical jargon to non-technical end users
Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting
Experience with HIPAA, data privacy, and/or data security processes
Experience working with regulators governing (public or private) health insurance carriers
Benefits
Employee benefits
Participation in Oscar's unlimited vacation program
Annual performance bonuses
Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance
Paid wellness time and reimbursements
Company
Oscar Health
Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products.
1001-5000 employees
H1B Sponsorship
Oscar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (19)
2024 (24)
2023 (22)
2022 (36)
2021 (13)
Funding
Current Stage
Public CompanyTotal Funding
$1.99BKey Investors
Tiger Global ManagementAlphabetFounders Fund
2025-09-16Post Ipo Debt· $355M
2021-03-03IPO
2020-12-17Private Equity· $140M
Leadership Team
Mark Bertolini
Chief Executive Officer
Steven B. Kelmar
Executive Vice President & COS
Recent News
Investor's Business Daily
2025-12-18
Investor's Business Daily
2025-12-13
Company data provided by crunchbase