Senior Manager, Revenue Cycle Management, Provider Operations

🕒 6 days ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $122.2k - $160.4k / year

⏰ Full Time

🟠 Senior

💹 Revenue Operations

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Own the strategy and performance of Oscar Medical Group'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 financial performance • Lead coding and documentation integrity strategies, including pre- and post-bill review, provider queries, addendums, signatures/co-signatures, documentation practice review, and provider education • Lead denial prevention and resolution strategies and implement sustainable corrective actions • Partner with clinical leadership on ICD-10/HCC documentation and coding • Evaluate payer-specific performance, requirements, and coding considerations and develop reimbursement, eligibility, claim-edit, and denial strategies • Partner with Clinical Operations, Finance, Compliance, Credentialing, Product/Technology, and other stakeholders on complex revenue cycle issues and new programs • Develop scalable revenue cycle policies, workflows, governance, and vendor oversight for a growing, multi-state provider organization • Advise Oscar Medical Group leadership on revenue cycle performance, financial opportunities, operational risks, and recommended strategies • Ensure compliance with applicable laws and regulations • Perform other duties as assigned

🎯 Requirements

• 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 • Ability to analyze complex revenue cycle data, identify trends and root causes, and translate findings into actionable strategies and recommendations • Experience leading complex, cross-functional initiatives and partnering with clinical, operations, finance, compliance, credentialing, and other stakeholders • Strong executive communication skills, with the ability to communicate complex revenue cycle performance, risks, opportunities, and recommendations to senior leadership

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Annual performance bonuses • Medical, dental, and vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life and disability insurance • Paid wellness time and reimbursements

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