Hi, we're Oscar. We're hiring a Reimbursement Policy Manager to join our Payment Integrity team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

As the Reimbursement Policy Manager, you will be responsible for developing, maintaining, and ensuring effective implementation and communication of claims payment policies for Oscar. The Reimbursement Policy Manager will build out and lead the Payment Policy Committee to manage the review and approval of policies. You will ensure Oscar’s payment policies meet all regulatory requirements and contractual obligations and align with our internal strategies. The Reimbursement Policy Manager is a highly cross-functional role and will work closely with our network, claims operations, claims configuration,

You will report to the Senior Director, Payment Integrity.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $108,000 - $141,750 per year. The base pay for this role in all other locations is: $97,200 - $127,575 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Develop and maintain payment policies for Oscar Health insurance through cross-functional alignment with our network and clinical teams.
• Ideate and recommend new payment policies or changes to existing policy and create payment criteria, based on regulatory changes, contracting changes, claims data insights and internal decision-making.
• Proactively surface any issues with existing policies and develop remediation plan.
• Build out and lead the Payment Policy Committee, managing the approval process for payment policies with cross-functional partners.
• Manage effective implementation and change management of new policies with cross-functional partners.
• Provide support to network teams and provider relations on communications to providers regarding payment policies.
• Ensure payment policies are compliant with regulatory requirements and contractual obligations.
• Ensure alignment of payment policies with our claims adjudication system.
• Maintain source of truth for payment policies and Policy Committee decision-making.
• Assess impact and lead approval of contracting decisions related to payment policy.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• A bachelor’s degree or 4+ years commensurate experience
• 4+ years of work experience in health insurance
• 4+ years of experience in developing and maintaining payment policies
• 3+ years of experience with end to end project management and change management
• Extensive knowledge of coding guidelines and payment methodologies

Bonus Points

• Commercial or ACA health plan experience
• Certified professional coder
• Medical chart auditing experience