Senior Manager, Revenue Cycle Management, Provider OperationsNew$792K–$178K

Oscar Health
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The opportunity

Hi, we're Oscar. We're hiring a Senior Manager, Revenue Cycle Management to join our Provider Operations team.

What you'll do

  • Own the strategy and performance of OMG's revenue cycle function, including: professional billing, coding, claims management, denials, eligibility, documentation, and related workflows.

  • Serve as the senior subject matter expert for coding and billing, including: CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, and payer requirements.

  • Establish and monitor revenue cycle KPIs and controls, using data and: root-cause analysis to improve clean claims, coding accuracy, reimbursement, denial rates, and overall financial performance.

  • Lead coding and documentation integrity strategies, including pre: and post-bill review, provider queries, addendums, signatures/co-signatures, identification of inappropriate documentation practices or cloning, and proactive provider education to address documentation gaps and support accurate coding.

  • Lead denial prevention and resolution strategies, identifying systemic trends: and partnering across teams to implement sustainable corrective actions.

  • Partner with clinical leadership on ICD-10/HCC documentation and coding,: identifying opportunities to improve accurate capture of clinically supported diagnoses.

What they're looking for

  • Evaluate payer-specific performance, requirements, and coding considerations,: developing strategies to address reimbursement, eligibility, claim edits, denials, and other revenue cycle issues while incorporating payer expertise into coding and operational processes.
  • Partner cross-functionally with Clinical Operations, Finance, Compliance,: Credentialing, Product/Technology, and other stakeholders to resolve complex revenue cycle issues and support new programs and services.
  • Develop scalable revenue cycle policies, workflows, governance, and vendor: oversight to support a growing, multi-state provider organization.
  • Advise OMG leadership on revenue cycle performance, financial opportunities,: operational risks, and recommended strategies, leading complex initiatives from identification through implementation and measurement.