Oscar

Recruitment

• Drive the daily tactical execution of provider recruiting by coordinating across multiple business units to ensure the team hits specific development goals, cost targets, and adequacy metrics.
• Supervise the creation and distribution of marketing and communication content, ensuring all team messaging is high-quality and accurately reflects our value proposition to prospective providers.
• Act as the direct supervisor for network recruiting analysts and associates, providing daily guidance, performance coaching, and technical mentorship to ensure high productivity.
• Monitor the team's adherence to recruitment policies and outreach workflows, identifying bottlenecks and ensuring every member follows optimized processes for maximum efficiency.
• Oversee the daily collection of recruitment data and adequacy metrics, preparing regular performance reports for leadership that highlight team wins and areas for improvement.
• Ensure the team provides prompt, accurate, and professional responses to all provider inquiries regarding contracting and participation, serving as the first point of escalation for complex issues.
• Facilitate the development of strong, long-term provider relationships within the team, personally managing high-value accounts to ensure network stability and team success.
• Compliance with all applicable laws and regulations)

Manager, Network Recruitment

Operations

• Ensure Oscar's provider data is maintained consistently
• Manage critical/complex data escalations to resolution
• Process provider and facility rosters
• Support updates to provider records
• Regular communication with providers via email
• Collaborate with internal teams by triaging, remediating, and analyzing root causes

Senior Analyst, Provider Data Operations

Full-stack Engineer

• Serve as the subject matter expert on business and technical domains.
• Lead the planning, execution and release of complex technical projects across multiple teams, including owning medium to large features or infrastructure projects from technical design through completion.
• Work with partners, product managers, and designers to solve challenging problems.
• Lead and mentor engineers and engineering teams to improve technology, apply best practices and set overall team direction.
• Responsible for ensuring the team’s delivery of large or complex technology capabilities (set of components or services) within their team's domain or spanning multiple domains.
• Facilitate, encourage, and enhance a culture of collaboration within the engineering team and its internal customers; recognizing when cross-team projects are at risk and actively mitigate risk to deliver on time.
• Prolific contributor to the objectives of their functional group, and plays a key role in driving outcomes for organization-wide projects.
• Work with leadership to assign prioritization of technical roadmap and influence prioritization of product roadmap and process enhancements within their area and across related areas.
• Actively identifies and reduces failure domains while working with their team to do the same.
• Builds software to minimize effort and business impact during maintenance and failures.
• Guide the development of Service-Level Objectives (SLOs) for systems they and their team are responsible for.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Staff Software Engineer, Fullstack

• Responsible for the accurate management and maintenance of provider data at Oscar
• Processing provider and facility rosters
• Reformatting data
• Supporting updates to provider records
• Regular communication with providers via email to confirm request completion, obtain additional information, and address follow-up inquiries
• Collaborating with internal teams by triaging, remediating, and escalating requests as necessary to ensure timely and effective resolution
• Building training materials and updating workflows
• Assisting in developing and maintaining standards for quality assurance

Provider Data Operations Specialist

Backend Engineer

• Become the expert on your team's business and technical domains
• Lead the planning, execution and release of complex technical projects
• Guide the development of Service-Level Objectives (SLOs) for systems
• Facilitate cross-team execution and collaboration

Senior Software Engineer, Backend

• Become the expert on your team's business and technical domains
• Lead the planning, execution and release of complex technical projects
• Work with partners, product managers, and designers to solve challenging problems
• Lead and mentor engineers on the team to improve technology and apply best practices
• Independently responsible for large or complex technology capabilities within their team's domain or spanning multiple domains
• Facilitates, encourages, and enhances cross-team execution and collaboration
• Prolific contributor to the objectives of their functional group
• Drives prioritization of technical roadmap and influences prioritization of product roadmap
• Actively identifies and reduces failure domains
• Builds software to minimize effort and business impact during maintenance and failures
• Guides the development of Service-Level Objectives (SLOs) for systems they are responsible for
• Own medium to large features or infrastructure projects from technical design through completion
• Compliance with all applicable laws and regulations

Medical Billing and Coding

• Responsible for daily operations pertaining to Risk Adjustment including but not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential CMS audits and medical record retrieval efforts.
• Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
• Participate in CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits.
• Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process.
• Support in the identification of document improvement opportunities for provider education in both MA and ACA line of business.
• Identify process improvements to enhance medical encounter review efficiency.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Risk Adjustment Coder, Specialist

• Maintain existing and incoming provider information to ensure accuracy and quality of the network by supporting complex non-standard provider information processing needs.
• Assist with administrative process improvements to enhance productivity
• Provide ongoing training and support to Credentialing Operations team members
• Conduct Primary Source Verification (PSV) and validate practitioner and facility credentials in compliance with NCQA standards
• Support employees on the team of all levels through escalation research and resolution
• Effectively communicate findings and resolutions with providers and internal departments inclusive of collaboration with cross-functional stakeholders
• Manage queue work and assigned caseload through effective dashboard management while ensuring integrity of information entered into company and external systems. Support junior employees in queue management and prioritization.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Senior Analyst, Credentialing Operations

Auditor

• Identify and conduct investigations into suspected FWA with high autonomy
• Document findings to include formal investigative reports, tables, graphs, audit logs, and other supporting documentation
• Met metrics to align with caseload, turn around times, and other unit-wide goals
• Continue to monitor providers with substantiated findings to track behavior change
• Participate in the development and presentation of FWA-related education for Oscar teams
• Build evidentiary files for potential recovery, legal action, and/or referrals to appropriate outside agencies
• Compliance with all applicable laws and regulations
• Other duties as assigned

SIU Coding Auditor

Bilingual

• Provide medical care virtually (both by phone and message)
• Provide patient care in alignment with Oscar Medical Group guidelines, practices and policies
• Focus on efficiency and quality of care delivery
• Ensure patient access to VUC services
• Collaborate with MAs, RNs, and other providers across service lines (e.g. primary care and health assessments)

Physician Assistant, Bilingual – Spanish

Compliance

• Serve as the subject matter expert on assigned state and federal policy for provider dispute and IDR legislative matters, while applying newly proposed and effective laws and regulations to processes as appropriate in assigned jurisdictions.
• With support from team leads, prepare clear, concise, user friendly briefing based upon case needs.
• Deliver multiple, simultaneous and diverse assignments while adhering to strict deadlines and managing competing priorities in a fast-paced environment.
• Serve as a point of contact for provider negotiations relating to IDR.
• Perform eligibility reviews of disputed claims to ensure all cases are routed to the appropriate venue
• Manage the end-to-end administrative lifecycle of each dispute by maintaining real-time updates on project management boards, gathering and redacting member documentation, and uploading supporting evidence to the appropriate portal stages within set regulatory deadlines
• Independently manage workload and related dependencies in compliance with required regulatory timelines
• Compliance with all applicable laws and regulations
• Other duties as assigned

Senior Analyst, Regulatory Affairs

• Research and Resolution of Regulatory Complaints
• Supports identification of escalated issues by using Oscar systems and processes
• Partners with internal business teams and leadership to share trends related to complaints received while proposing solutions to prevent recurrence
• Advise teammates on potential solutions to current regulatory complaints
• Develop and maintain successful relationships with state insurance regulators
• Compliance with all applicable laws and regulations.

Regulatory Complaints Associate

• Manage the execution of required annual QHP filings with state regulators, state exchanges, and CMS
• Develop and maintain successful relationships with regulatory agencies and CMS
• Serve as an advisor to teammates and cross-functional teams to drive accurate completion of filing deliverables
• Develop sustainable processes to simplify outputs while ensuring high quality deliverables
• Manage other projects in support of filings while achieving deadlines and managing competing priorities
• Compliance with all applicable laws and regulations
• Other duties as assigned

Regulatory Operations, Associate

• Perform quality checks of other team members' coding audit reviews and deliver in written or verbal form to ensure accuracy and compliance with coding standards and Oscar policy.
• Review dashboards and interpret performance data in support of production goals; Recommend response and inform management before deadlines are missed.
• Identify and help develop new processes to ensure efficient and effective audit functions.
• Perform complex reviews of medical records and claims on both a prepayment and post payment basis to determine accuracy of claims submitted to Oscar.
• Explicitly document findings including sources used to support decision making and in a way that can be easily understood by non clinicians or coders.
• Participate in educational calls or written communications to articulate findings to providers under SIU review.
• Facilitate team and cross-team education
• Compliance with all applicable laws and regulations