Manager, Reimbursement Policy

Hi, we're Oscar. We're hiring a Manager, Reimbursement Policy to join our Claims & Benefits 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 Manager, Reimbursement Policy, you will be responsible for developing, maintaining, and ensuring effective implementation and communication of provider reimbursement policies for Oscar. You will build out and lead the Reimbursement Policy Committee to manage the review and approval of policies. You will ensure Oscar’s reimbursement policies meet all regulatory requirements and contractual obligations and align with our internal strategies. The Manager, Reimbursement Policy is a highly cross-functional role and will work closely with our network, claims operations, claims configuration, clinical and provider relations teams.

You will report to the Senior Director, Claims.

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 Ave), 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, Kentucky, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, 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 provider reimbursement policies for Oscar Health insurance through cross-functional alignment with our network and clinical teams.
• Ideate and recommend new reimbursement policies or changes to existing policy and create reimbursement 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 reimbursement Policy Committee, managing the approval process for reimbursement 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 reimbursement policies.
• Ensure reimbursement policies are compliant with regulatory requirements and contractual obligations.
• Ensure alignment of reimbursement policies with our claims adjudication system.
• Maintain source of truth for reimbursement policies and Policy Committee decision-making.
• Assess impact and lead approval of contracting decisions related to reimbursement policy.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• 5+ years of health plan experience
• 4+ years of experience in developing and maintaining reimbursement policies
• Extensive knowledge of coding guidelines and reimbursement methodologies
• Strong project management and change management skills
• Strong written and verbal communication skills

Bonus Points

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

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives..

Pay Transparency: 

Final offer amounts,