Revenue Cycle Leader, Provider Operations — Hybrid NYC

Oscar-Health-; New York (NY); Hybrid; USD 136,000 - 178,000; Full time

Benefits offered by this job

Unlimited vacation

Annual performance bonus

Benefits package

Job summary

Oscar Health is seeking a Senior Manager, Revenue Cycle Management for Provider Operations in New York City. The role leads OMG's revenue cycle performance across billing, coding, denials, and workflows, with a focus on accuracy, timely reimbursement, and risk mitigation.

You will partner with clinical, operations, finance, compliance, credentialing, and product teams, driving strategic improvements and establishing KPIs.

Qualifications

• 7+ years of progressive experience in healthcare revenue cycle, professional billing, coding, or related healthcare operations.
• 3+ years of experience leading revenue cycle programs, teams, or functions with accountability for operational and/or financial outcomes.
• Advanced knowledge of professional billing and coding, including CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI edits, claims management, denial management, and payer requirements.
• Experience developing and executing revenue cycle strategies that improve coding accuracy, claims performance, reimbursement, and overall financial outcomes.
• Experience with coding and clinical documentation integrity, including provider documentation review, provider queries, and pre- and post-bill review processes.
• Demonstrated ability to analyze complex revenue cycle data, identify trends and root causes, and translate findings into actionable strategies and recommendations.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P), Certified Professional Medical Auditor (CPMA), or comparable coding/revenue cycle certification.

Responsibilities

• 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, and address documentation gaps.
• 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.
• Evaluate payer-specific performance, requirements, and coding considerations, developing strategies to address reimbursement, eligibility, claim edits, denials, and other revenue cycle issues.
• 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.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

Revenue cycle management

Leadership

Cross-functional collaboration

Data analysis

Executive communication

Job description

Oscar Health is seeking a Senior Manager, Revenue Cycle Management for Provider Operations in New York City. The role leads OMG's revenue cycle performance across billing, coding, denials, and workflows, with a focus on accuracy, timely reimbursement, and risk mitigation.

You will partner with clinical, operations, finance, compliance, credentialing, and product teams, driving strategic improvements and establishing KPIs.