Senior Revenue Cycle Leader, Provider Ops (Hybrid)

Oscar Health; Phoenix (AZ); Híbrido; USD 122 000 - 160 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Unlimited vacation program

Annual performance bonuses

Resumo da oferta

Oscar Health is looking for a Senior Manager, Revenue Cycle Management to lead the Provider Operations revenue cycle functions from Tempe, AZ with a hybrid schedule. You will own professional billing, coding, claims management, denials, eligibility, and documentation workflows to optimize financial performance.

You will partner across clinical operations, finance, compliance, credentialing and product teams, guiding strategy and ensuring accurate coding and compliant billing.

Qualificações

• 7+ years in healthcare revenue cycle, professional billing, coding or related operations.
• 3+ years leading revenue cycle programs, teams, or functions with accountability for outcomes.
• Advanced knowledge of professional billing and coding: CPT, ICD-10-CM, HCPCS, modifiers, CCI/NCCI, payer requirements.
• Experience developing revenue cycle strategies to improve coding, reimbursement and financial outcomes.
• Experience with coding and clinical documentation integrity, including provider documentation review and pre-/post-bill review.
• Ability to analyze complex revenue cycle data, identify trends and translate into actionable strategies.
• Experience leading cross-functional initiatives with clinical, operations, finance, compliance, credentialing, and other stakeholders.
• Strong executive communication skills for presenting performance, risks and recommendations to senior leadership.

Responsabilidades

• Own strategy and performance of OMG's revenue cycle function: professional billing, coding, claims, denials, eligibility and related workflows.
• Serve as SME for coding and billing: CPT, ICD-10-CM, HCPCS, modifiers, payer requirements.
• Establish and monitor revenue cycle KPIs and controls; improve clean claims, coding accuracy and reimbursement.
• Lead coding and documentation integrity strategies: pre-/post-bill reviews, provider queries, addenda, signatures, and addressing clustering or cloning.
• Lead denial prevention and resolution strategies; identify systemic trends and drive corrective actions.
• Partner with clinical leadership on ICD-10/HCC documentation and coding for improved capture.
• Evaluate payer-specific performance and requirements; address revenue cycle issues while incorporating payer insights.
• Collaborate cross-functionally to resolve complex revenue cycle issues and support new programs.
• Develop scalable revenue cycle policies, workflows, governance and vendor oversight.

Conhecimentos

Revenue cycle

Professional billing

Coding (CPT/ICD-10-CM/HCPCS)

Denials management

Cross-functional leadership

Executive communication

Data analysis

Descrição da oferta de emprego

Oscar Health is looking for a Senior Manager, Revenue Cycle Management to lead the Provider Operations revenue cycle functions from Tempe, AZ with a hybrid schedule. You will own professional billing, coding, claims management, denials, eligibility, and documentation workflows to optimize financial performance.

You will partner across clinical operations, finance, compliance, credentialing and product teams, guiding strategy and ensuring accurate coding and compliant billing.