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Job DescriptionDescription: The Claims Analyst Role is a key driver for ClaimInsight towards continued maturity, growth, and success. The role requires a commitment to innovation, as a successful analyst will seek, analyze, develop, and help implement strategic initiatives for improved efficiency and productivity under management guidance. We are currently seeking a Healthcare Coding and Claims Analyst to perform detailed retrospective analytical reviews of inpatient and outpatient (professional/physician) claims. This role involves evaluating coding accuracy, documentation completeness, billing compliance, correct policy application, and reimbursement outcomes across various care settings. The analyst will review coding scenarios, apply industry coding guidelines, and support auditing activities to ensure compliance with regulatory standards, payer requirements, and internal policies. The ideal candidate should possess strong analytical skills, a deep understanding of medical coding and claims workflows, and demonstrated experience in conducting retrospective reviews to identify trends, errors, and opportunities for process improvement/overpayment detection. You will accomplish this through: Essential Job Duties: Claims Review & Analysis- • Perform retrospective analytical reviews of inpatient and professional claims to evaluate coding accuracy, billing integrity, and reimbursement outcomes., • Validate clinical documentation supports assigned codes, modifiers, and levels of service., • Identify patterns of coding errors, under-coding, over-coding, or potential compliance risks. Coding & Documentation Auditing- • Conduct internal audits of medical coding, clinical documentation, and claim submissions to ensure compliance with CMS, OIG, commercial payer, and internal policies., • Prepare audit findings, summaries, and recommendations for education or corrective action., • Assist in developing and refining audit tools, workflows, and tracking processes., • Collaborate with coding teams, clinical staff, and billing departments to clarify documentation and coding issues. Data Analysis & Reporting- • Analyze datasets of claim activity to identify trends, anomalies, and areas for improvement., • Prepare clear and concise reports for summarizing findings, root-cause analysis, and recommended interventions., • Support the development of dashboards or monitoring tools to track coding accuracy and audit outcomes. Compliance & Quality Assurance- • Stay current with changes in coding guidelines, regulatory updates, and payer billing policies., • Ensure claims adhere to federal/state regulations, payer contracts, and organizational standards., • Support quality improvement initiatives focused on documentation, coding, and reimbursement accuracy. Cross-Functional Collaboration- • Partner with coding, revenue cycle, clinical, and recovery teams to resolve coding or billing discrepancies., • Provide staff education on audit findings, coding best practices, and documentation requirements., • Participate in meetings and workgroups related to coding quality, documentation integrity, and compliance.Requirements: Skills and Abilities: • Proven experience in retrospective analytical review of inpatient and professional claims., • Deep knowledge of ICD-10-CM/PCS, CPT, HCPCS, DRG methodology, APCs, and payer reimbursement rules., • Strong analytical, critical thinking, and problem-solving skills., • Experience working with EMRs, coding software, and claims/billing platforms., • Excellent communication and technical writing skills., • Ability to manage multiple priorities with accuracy and attention to detail., • Competency in Microsoft applications, including Word, Excel, and Outlook. Education/Certification and Experience: • Bachelor's Degree Preferred, • Five or more years of experience in claims analysis or a related field, • Certified Professional Coder (CPC) from AAPC and/or Certified Coding Specialist (CCS) certification from AHIMA for medical coding or similar credentials strongly preferred. Physical Requirements: • Indoor office environment with moderate noise, • Travel is required for on-site client visits approximately 10% of the time., • Intermittent physical effort may include lifting to 25 lbs., walking, stopping, kneeling, crouching, or crawling may be required, • Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing, • Normal vision abilities required, including close vision and the ability to adjust focus

Job Description Certified Medical Coder (Remote Production Role) Our mission to change wound care and improve the lives of others isn’t easy, but it’s worth it! One in ten residents in a skilled nursing facility will develop a skin condition requiring expert medical care. We believe that every person deserves the very best wound care. Building and leading wound care teams is how we do it! Our wound care providers bring education and encouragement to the people who take care of our patients 24/7. When they get better at their jobs, our patient’s wounds heal faster and that is our goal! Main Responsibilities (may include but are not limited to): • Meet minimum production goals while maintaining accuracy requirements, • Review provider medical coding of services rendered for medical claim submission, • Review and respond to medical coding inquiries submitted by providers and staff, • Work directly with providers to resolve specific medical coding issues, • Analyze data for errors and report data problems, • Partner with billing office to correct and resubmit claims based on review of the records, provider input, and payor input, • Work with clinical and non-clinical groups to identify undesirable coding trends, • Ensure claims are medically coded consistently by following CPT, ICD-10 and HCPCS rules and guidelines; escalate issues that may impact this immediately to the Compliance Committee, • Abide by HIPAA and Coding Compliance standards, • Collect data from various sources, maintain electronic records and logs, file paperwork, and operate office equipment, • Accomplish other tasks as assigned Other Duties That May be Assigned: • Work hand in hand with partner facilities to verify resident stay status, • Review patient information to assist in decision making process in regard to advance modalities, • Coordinate with outside partners for advanced modalities Skills required to succeed: • Must live in one of the following states: WA, OR, ID, UT, AZ, TX, VA, FL, GA, PA, IA, • 2+ years coding, • 2+ years medical billing experience (preferred but not required), • Experience with insurance and revenue cycle management processes, • Ability to read and understand insurance EOB’s, • Proficient in reviewing edits between CPT, ICD10, and HCPCS codes, • Experience in reviewing insurance review denials and payer policies, • Professional coder certification through a recognized organization such as AAPC (preferred) or AHIMA, • Leadership qualities with the ability to effectively educate providers remotely, • Acute attention to detail with a strong, self-sufficient work ethic, • Excellent organization and use of time management skills, • Ability to prioritize workload and have a strong sense of urgency when time sensitive situations arise, • Proficient with computers and navigating within multiple applications, • Proficient in MS Office (specifically Teams, Outlook, Excel, and Word), • Ability to collaborate with other UWH team members electronically via email, messaging, and telephone conferences, • Strong verbal and written communication, as well as customer service skills; must be able to listen and communicate effectively with leadership, providers, and co-workers, • Goal-oriented and a consistent performer, • Must be self-motivated, punctual, dependable, and able to work independently, • Must be trustworthy, honest and have a positive and professional attitude Location: Remote – corporate office location in WA Compensation: $25.00 - $33.00 hourly - DOE and location This position is classified as: Hourly, Non-Exempt; Full-Time employment Hours: Typical hours are Monday through Friday; 7:30am – 4:00pm PST, (occasional overtime depending on claim volume) Benefits: • Work remotely from a home office, • Associates working 20+hrs per week:, • Medical/Dental/Orthodontic/Vision/RX - 80% towards employee monthly premiums covered, HSA, dependent coverage available at employee’s expense, • Employer Sponsored Life, AD&D, and Disability Insurance, • Voluntary Supplemental Insurance: Accident, Cancer, Critical Illness, STD, Life, • Paid Time Off:, • Accruals up to 132 hours (16.5 days) your first year of employment based on 1.0FTE status, • 8 paid Holidays for full-time employees, • 401(k) match on first 4%, • Core Values that promote work-life harmony, • Work with amazing people who have created a culture where we recognize each other’s wins and don’t tolerate gossip or drama Website: *Do you want to grow personally and professionally by working with the best? We’d love to hear from you! Apply now: We are a drug-free workplace. All offers of employment are contingent upon a successful drug screen and criminal background check. EEO.

Job DescriptionAbout Optima Medical: Optima Medical is an Arizona-based medical group consisting of 30 locations and 130+ medical providers, who care for more than 200,000 patients statewide. Our mission is to improve the quality of life throughout Arizona by helping communities "Live Better, Live Longer" through personalized healthcare, with a focus on preventing the nation's top leading causes of death. We go beyond primary care with a full spectrum of services including cardiovascular health services, behavioral health, allergy testing and immunotherapy, in-house lab testing, imaging, chronic disease management, and other specialty health services. We aspire to aid the growth of our company by welcoming the most qualified and dedicated professionals aboard. We are currently seeking an HCC Coder to join our team! This role will transition to a fully remote position after your first 60 days. To be eligible, you'll need to complete your initial 60 days onsite at our Scottsdale office and remain in good standing. Must reside in Arizona! Job Responsibilities: • Perform code abstraction of medical records, diagnostic imaging, etc. to ensure ICD-10-CM codes to identify diagnoses relevant for HCC risk adjustment are accurately assigned and supported by clinical documentation, • Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education., • Assist by making recommendations for process improvements to further enhance coding goals and outcomes., • Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations., • Meet minimum productivity requirements as outlined by the project terms., • Minimum of 1 year of coding experience in Risk Adjustment. (2 years preferred), • Must have a coding certification through AAPC or AHIMA (CPC, CRC, etc.), NO CPC-A or CCA, • Ability to consistently maintain a high level of accuracy working in a fast-paced production environment., • High school diploma or equivalent., • High level of competency in Microsoft Outlook, Word, and Excel., • Strong written and verbal communication skills., • Works independently under regular supervision., • Substantial growth opportunities, • Leadership and mentoring, • Fun work environment (lunches, events, holiday parties), • Comprehensive benefits (medical/vision/dental/401k/paid holidays), • Supportive and positive work culture

Job Description Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • 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, • Bachelor's degree in a relevant field of study or commensurate work experience., • Certified professional coder (CPC), • Certified Risk Adjustment Coder (CRC) or similar certification 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, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job DescriptionDescription: Care Coordinator Float - EndovascularJob Details Job Type Full-time Phoenix, AZ Description JOB SUMMARY: The Care Coordinator Float provides support with the daily activities of a medical office including filing, telephone coverage, appointment scheduling, registration, and patient referrals by performing the following duties. Interacts with patients, staff, hospital personnel, and other professionals to improve patient satisfaction and quality control of billing information, reduce duplication of work measured by lowering cost per patient intake, and reduce the number of claim rejections on initial submission. JOB DUTIES & RESPONSIBILITIES: • Registers new patients in Athena prior to scheduling appointment with correct demographic and insurance information., • Makes sure all initial consultations, pertinent notes, lab slips, radiology and pathology reports are available to the physician prior to patient arrival., • Answers telephone and either responds to inquiry, directs caller to appropriate personnel, or initiates a triage slip for response by medical personnel., • Schedules appointments and immediately enters appointment date and time into computerized scheduler., • Responsible for knowing the physician's personal schedule and coordinating it with the clinical and surgical schedules., • Assists Medical Assistants and Practice Coordinators as needed., • Retrieves authorization from insurance carrier for services., • Enters office and surgical appointments directly into Athena and physicians’ personal Outlook calendar., • Prepares and runs clinics., • Schedules outpatient testing., • Conducts reminder calls to all patients., • Greets and directs patients, salespeople, and visitors., • Registers patients by verifying that the patient's record is up to date and accurate. Makes appropriate changes in computer system., • Provides coverage to other positions as requested., • Coordinates referrals for patients through insurance and other physician offices., • Prepares all billings in computerized system for processing by Business Office., • Codes office charges on e-ticket and sends appropriate op notes and coding information to coder within 5 days of service., • Working knowledge of ICD-10 and CPT coding., • Tracks incoming scans for film reviews for upcoming consultations/office visits., • Able to perform all jobs within the office setting when other employees are absent., • Reports to work regularly on time for all scheduled shifts., • Maintains positive attitude and demonstrates the utmost in professionalism., • Dresses appropriately and professionally., • Completes work accurately and in a timely manner., • Excellent oral, written & telephone communication skills, along with tact, diplomacy, and strong customer service orientation., • Prioritizes work activities and receives and assumes multiple job duties., • Graduate of a formal program in Medical Assisting, accredited by the Commission of Accreditation of Allied Health Education Programs (CAAHEP)., • Work is performed in an office environment, with contact with patients, office staff, physicians, etc., • Travel to different clinic locations as required.

Job Description Hi, we're Oscar. We're hiring an Associate, SIU Coding Auditor to join our SIU. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Associate, Special Investigations Unit Coding Auditor executes on Oscar's anti-fraud initiatives by supporting operational and financial targets while adhering to legal and regulatory obligations. You will help execute on audit strategy by ensuring team productivity is met while ensuring quality remains high. The associate networks across all partners, and recommends enhancements to processes, policies, and procedures to support a best in class Fraud Waste and Abuse program. We ask that you have attention to detail, innovation, and ability to shift priorities to align with operational needs. You will report into the Manager, SIU Coding Audit. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $75,265 - $98,785 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • 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, • Bachelor's degree or equivalent years of experience, • Certified Professional Coder (CPC) designation or similar, • Certified Professional Medical Auditor, • 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, • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting., • Experience with HIPAA, data privacy, and/or data security processes 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, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job DescriptionDescription: Our World-Class Team Begins with YOU! Barrow Brain and Spine is a physician-owned specialty practice focused in the areas of neurosurgery and advanced spine care and pain management. As a partner of Barrow Neurological Institute, the practice encompasses 42 neurosurgeons, 8 physiatrists and performs more than 10,000 surgeries each year. This globally recognized group directs the Neurosurgery Residency Program at St. Joseph’s Hospital in Phoenix, Arizona and serves more than 21,000 patients per year. Do you have what it takes to be part of our World-Class team? At Barrow Brain and Spine, each team member is dedicated to the highest levels of performance, integrity, collaboration, and commitment to patient care. These are not just words on a page, this is our culture. If you are looking for an extraordinary work environment dedicated to enhancing the lives of our patients and team members, we look forward to hearing from you. Job Information: As one of the largest private group practices in the US, BBS is looking for a Lead Care Coordinator to join our Ahwatukee Team 2 days per week. This position will also travel to Gilbert 2 days per week and to Chandler 1 day per week. Essential Duties and Responsibilities: • Oversee the daily workflow of physician’s office. Provides direct support to physician and Care Coordinator as needed., • Manages staff work schedules to reflect volume and operational need. Reviews and approves employee timesheets and PTO requests in accordance with BBS guidelines., • Manages physician’s personal, clinical, and surgical schedules. Ensure all appointments are reflected in the physician’s Outlook and personal calendar. Manages physician’s travel schedule and arrangements., • Ensure proper medical reports are available to the physician prior to patient arrival., • Triages telephone calls when Care Coordinator is not available., • Obtains authorization from insurance carriers for surgeries in accordance with hospital guidelines., • Schedules surgeries and outpatients testing. Maintains patients recalls., • Coordinates referrals for patients through insurance and other physician offices., • Trains new Care Coordinators on patient registration, scheduling, taking vitals, rooming patients, entering orders, using medical equipment and supplies, arranging referrals, and other clinical operations required for the daily clinic workflow. We offer a comprehensive compensation package. This includes benefit offerings you’d expect to see at a large company, all designed to help you take good care of yourself and your family. The benefits include: • Choice of two types of medical plans – 2 HDHP/HSA options & 1 PPO/HRA option, • Dental and Vision plans, • Disability – short-term & long-term, 100% employer paid., • Basic Life/AD&D, 100% employer paid., • Voluntary Life/AD&D available for employee, spouse, and children, • Voluntary Critical Illness and Accident coverage, • Paid Time Off, • Paid Holidays Preferred method of response is via our Careers page: barrowbrainandspine.com Requirements: Qualifications: • HS diploma or GED required., • 2 years in a medical setting required., • Experience with athenaOne a plus!

Job Description Hi, we're Oscar. We're hiring a Senior Analyst, Special Investigations Unit Clinical Investigator to join our SIU. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Senior Analyst, SIU Clinical Investigator detects and audits aberrant billing patterns within claims and clinical documentation, using forensic clinical expertise to protect the integrity of healthcare spend. You will perform comprehensive pre-payment and post-payment reviews of medical records to ensure billed services align with established clinical guidelines, CMS regulations, and contractual obligations. Beyond individual claim accuracy, you will analyze provider behavior to identify schemes such as record cloning, upcoding, and unbundling that may be invisible to automated systems. As a clinical subject matter expert, you will act to translate audit findings into relevant education. You will facilitate professional discussions with colleagues and providers to correct billing behaviors and promote long-term compliance. You will partner with clinical and non-clinical investigators to build evidentiary files for potential recovery, legal action, or referrals to appropriate outside agencies. You will report into the Investigations Manager, SIU. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Identify and conduct clinical audits into suspected FWA with high autonomy, • Document findings, to include formal reports, graphs, audit logs, and other supporting documentation., • Metrics to align with unit goals., • Participate in the development and presentation of FWA-related education for Oscar teams, • Compliance with all applicable laws and regulations, • Active, unrestricted Registered Nurse (RN) license, • 3+ years of direct patient care clinical experience. Case Management experience a bonus., • 2+ years of experience in Medical Review, Utilization Management, or Clinical Documentation Improvement, featuring demonstrated expertise in the forensic application of complex clinical guidelines (e.g., MCG, CMS, and specialty-specific professional organizations) to multifaceted medical records., • Bachelor of Science in Nursing (BSN), Associate Degree in Nursing (ADN) with a Bachelor of Science in Health Administration, Clinical Informatics, or a related Medical Science field, or Associate Degree in Nursing (ADN) with 5+ years of specialized clinical audit experience., • Experience working in health insurance with competency regarding claims processing, billing, reimbursement, or provider contracting., • Experience delivering feedback or education to providers/physicians in a professional, non-confrontational, and persuasive manner., • Identifying trends, for example "cloned documentation" or change in billing habits of a provider., • Experience with HIPAA, data privacy, and/or data security processes 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, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Job Description Hi, we're Oscar. We're hiring a Senior Analyst, SIU Investigator to join our SIU team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Senior Analyst, SIU Investigator identifies and investigates aberrant behavior observed in medical claims data and member enrollment data. You will manage an investigative caseload from case identification through to resolution, including data mining, investigation planning, data analysis, sampling, medical records requests, audit interpretation, overpayment recovery, reporting to regulatory agencies and monitoring ongoing provider behavior. The Senior Analyst will meet metrics set forth related to caseload, turn around times, and other unit-wide goals. You will report into the Investigations Manager, SIU. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $64,832 - $85,092 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • 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, • 3+ years of healthcare fraud investigation experience or professional investigation experience with law enforcement agencies, • Bachelor's degree in Criminal Justice or a related field, • Experience with HIPAA, data privacy, and/or data security processes, • Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] and Fraud Professional (CAFP), or similar 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, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

R-401412 Description The Physician serves as a health-care professional and capable of handling a variety of health-related problems. The Physician work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities Humana’s Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating over 175 centers across eight states under two brands: CenterWell & Conviva. Operating as a payor-agnostic, wholly owned subsidiary of Humana, our centers put the unique needs of seniors at the center of everything we do. Our Clinics offer a team-based care model where our physicians lead a multi-disciplinary care team supporting patient’s physical, emotional, and social wellness. At CenterWell Senior Primary Care we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all. The Primary Care Physician (PCP) works as a lead in our team-based care environment. We are a value-based care provider focused on quality of care for the patients we serve. Our care team consists of Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators and more. Our approach allows us to provide an unmatched experience for seniors. Our model is positioned to provide higher quality care and better outcomes for seniors by providing a concierge experience, multidisciplinary services, coordinated care supported by analytics and tools, and deep community relationships. This robust support allows our PCP to see fewer patients and spend more time with those they do. Responsibilities • Evaluates and treats center patients in accordance with standards of care., • Follows level of medical care and quality for patients and monitors care using available data and chart reviews., • Assists in the coordination of patient services, including but not limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care., • Acts as an active participant and key source of medical expertise with the care team through daily huddles., • Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in practice by displaying a professional and approachable demeanor., • Completes all medical record documentation in a timely manner working with a quality- based coder to optimize coding specificity., • Follows policy and protocol defined by Clinical Leadership., • Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues., • Participates in potential growth opportunities for new or existing services within the Center., • Participates in the local primary care “on-call” program of CenterWell as needed., • Assures personal compliance with licensing, certification, and accrediting bodies., • Current and unrestricted medical license or willing to obtain a medical license in state of practice; eligible and willing to obtain licenses in other states in the region of assignment, as required., • Graduate of accredited MD or DO program of accredited university., • Excellent verbal and written communication skills, • Bilingual English & Spanish Required., • Demonstrate a high level of skill with interpersonal relationships and communications with colleagues/patients., • Fully engaged in the concept of “Integrated team-based care” model, • Willingness and ability to learn/adapt to practice in a value-based care setting., • Superior patient/customer service, • Basic computer skills, including email and EMR., • Board Certification or Eligible to become certified (ABMS or AOA) in Family Medicine, Internal Medicine or Geriatric Medicine preferred., • Active and unrestricted DEA license, • Medicare Provider Number, • Medicaid Provider Number, • Minimum of two to five years directly applicable experience preferred., • Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care environment in a value-based relationship environment., • Knowledge of Medicare guidelines and coverage, • Guaranteed base salary + quarterly bonus., • Excellent benefit package – health insurance effective on your first day of employment, • CME Allowance/Time, • Occurrence Based Malpractice Insurance, • Relocation, • 401(k) with Employer Match, • Life Insurance/Disability, • Paid Time Off/Holidays For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve. If Progressed to Offer, You Will Be Required To • Provide proof of full vaccination or commit to testing protocols OR #physiciancareers Scheduled Weekly Hours 40

Hiring a HYBRID Medical Coder role in Phoenix, AZ! Schedule: • First 90 Days: 100% onsite, • After 90 Days: Hybrid (4 days remote, 1 day onsite per week), • M-F start time between 7-8 AM Pay Range: $23-$28/hr depending on qualifications Day to day: • Assign accurate ICD-10, CPT, and modifier codes for physician and ASC services, • Perform detailed chart reviews to validate documentation and ensure compliant charge capture, • Code surgical cases, including modifier review and application, • Resolve coding-related claim rejections and denials, • Review and edit charges entered by clinic staff to ensure accuracy, • Post payments and assist with deposit application as needed, • Support charge reconciliation and ensure all services are appropriately captured, • Maintain productivity and quality benchmarks, • Collaborate with internal departments to improve reimbursement and reduce revenue leakage Benefits: • In order to be eligible for health benefits, you must be employed for 30 days and must average 30 hours per week over your first four weeks on assignment. If you become eligible and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s). 401(k) Retirement Plan (After 6+ months of service, during a 401K enrollment period) Medical, dental and vision plans with The American Worker, as well as three Major Medical Plan options! Prescription Programs Short Term Disability Insurance Term Life Insurance Plan Compensation: Dependent upon experience Apply Today!

Completion of a formal coding program with the following certification required: Certified Professional Coder (CPC), Certified Coding Specialist - Physician-based (CCS-P), or equivalent AAPC or AHIMA approved coding credential. The Medical Coding Specialist plays a key part in ensuring accurate codi

An inpatient hospital medical coder is a healthcare professional responsible for reviewing and analyzing patient medical records from hospital stays and assigning standardized codes for diagnoses and procedures. Current coding credential: CCS RHIT or RHIA (AHIMA). Experience with Level 1 Trauma Codi

Minimum of 3 years of inpatient coding experience at a Level I Trauma Center, preferably within an academic medical facility. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components

Certified Coder - Neurology (On-site). IMS Care Center is currently searching for a professional, compassionate and knowledgeable individual to fill the position of Certified Coder for our Neurology Clinic in Phoenix. The Certified Coder will be accountable for processing medical claim information t

DoD medical coding, re-coding, abstraction, analysis, and assembly of medical record data. Medical, Rx, Dental & Vision Insurance. Medical & Dependent Care Flexible Spending Accounts.

Are you a certified primary care medical coder who s passionate about improving the accuracy and integrity of patient records? Valleywise Health wants you to join our mission-driven team focused on providing exceptional patient care through precise a Risk, Coder, Clinical, Microsoft, Medical, Health